Unjust and Unhealthy

Map of Zambian Prisons Visited

Fact Sheet

Table 1: Basic
Statistics for Prisons Visited

Table 2: Access to Justice
for Prisoners Interviewed

*Under Zambian law,
a prisoner under the age of nineteen years (the minimum age of criminal
responsibility is eight years) is classified as a “juvenile,”
despite the fact that under international law, 18 year-olds are adults.

Categories of Prisoners Held in Zambian Prisons Under Zambian Law

Convicted criminal prisoner (convict): A prisoner serving
a sentence, having been found guilty of a criminal offense by a court.

Unconvicted prisoner (remandee): Any person
committed to custody by a court order or order of detention who is not a
convicted criminal prisoner.

Juvenile: Under Zambian law, a prisoner under the
age of nineteen years (the minimum age of criminal responsibility is eight
years) is classified as a “juvenile,” despite the fact that under
international law, 18 year-olds are adults. Throughout this report, the term “juvenile”
will be used to designate the category of prisoners ages eight to 18 held in
Zambian prisons when necessary to refer to the classification used by the
government. Otherwise, individuals in prison under age 18 will be referred to
as “children” in accordance with the Convention on the Rights of
the Child.

Prohibited Immigrant: A prisoner detained under a
broad range of alleged immigration-related violations, including visitors
with an expired permit to remain in Zambia, individuals entering Zambia
without being able to establish a valid passport, and persons previously
deported from Zambia. Throughout this report, individuals detained under the
“prohibited immigrant” classification will be referred to as
“immigration detainees”.

Summary

I have seen people die in the night in the
cell—there is nothing we can do. We shout for someone, but the guards
will say, “he is just playing sick, he wants to escape. Let us wait two
or three days, and see how he will be.” And then he dies.

–
Nickson, 36, Mukobeko Maximum Security Prison, September 30, 2009

They say, “you’re going to Chimbokaila
[Lusaka Central Prison]? It’s a death sentence.” Not because they
are afraid you will be given beatings, but because of TB. They know the
conditions are bad.

People who break the law should be held accountable. The
appropriate punishment may be imprisonment. But for detainees in Zambian
prisons—a third of whom have never been convicted of any crime—being
held behind bars can have life-threatening consequences. Overcrowding,
malnutrition, rampant infectious disease, grossly inadequate medical care, and routine
violence at the hands of prison officers and fellow inmates make Zambian
prisons death traps.

Zambia’s prison system is in crisis. Built to
accommodate 5,500 prisoners before Zambian independence in 1964, the country’s
prisons housed 15,300 in 2009. Between September and October 2009, the Prisons
Care and Counselling Association (PRISCCA), AIDS and Rights Alliance for
Southern Africa (ARASA), and Human Rights Watch visited six facilities, two of
which were filled at 573 percent and 622 percent of capacity, respectively.
Some inmates are forced to sleep seated, or in shifts.

Inmate health problems are compounded by practices
prohibited under international law as inhuman and degrading treatment or as
torture, such as corporal punishment and “penal block” isolation
practices, where prisoners are stripped naked and left in a small, windowless
cell while officers pour water onto the floor to reach ankle or mid-calf
height. There is no toilet in the cell, so inmates must stand in water
containing their own excrement. Certain inmates—appointed as “cell
captains” by officers—are also invested with disciplinary authority
and mete out the overwhelming majority of punishments, through night-time
“courts” in their cells and beatings. Beatings are particularly
harsh when aimed at inmates engaging in same-sex sexual activity, and at
prisons with associated farm facilities, where inmates’ hard labor
conditions closely resemble slave labor.

Water is unclean or unavailable; soap and razors are not
provided by the government. The food provided by the Prisons Service is so
insufficient and nutritionally inadequate that food has become a commodity
traded for sex or labor in the prisons.

In October 2009, the Zambia Prisons Service employed only 14
health staff—including one physician—to serve its 15,300 prisoners.
Of Zambia’s 86 prisons, only 15 had any health clinic or sick bay, many
of these with little capacity beyond distributing paracetamol. For those
prisons without a clinic—and for more serious medical conditions at those
with a clinic—access to care is controlled by medically unqualified and
untrained prison officers. Lack of adequate prison staff for the transfer of
sick prisoners—as well as lack of transportation and fuel—and security
fears also conspire to keep inmates from accessing medical care outside of the
prisons, in some cases for days or weeks after they fall ill.

Even while largely unknown and unmeasured, tuberculosis (TB)
transmission is a constant and serious threat in the prisons’ cramped, dark,
unventilated cells. Suspected prevalence rates are very high, with the Zambia
Prisons Service reporting an incidence rate for TB of 5,285 cases per 100,000
inmates per year. Rates in Zambia outside of prison in 2007 were less than one-tenth
as high.

Only 23 percent of prisoners we interviewed had been tested
for TB. The conditions at each of the prisons we visited—combining
overcrowding, minimal ventilation, and a significantly malnourished and
weakened population—are ripe for the quick spread of TB. The TB isolation
cells designed to house the ill are in such poor condition that even the physician
in charge of the prison medical directorate deems them “death
traps”—yet, since they are slightly less crowded than standard
cells, inmates who completed TB treatment told us that they sometimes chose to remain
in the cells with inmates with active TB so as to avoid the worst of the
desperate overcrowding elsewhere.

The prevalence of HIV in Zambian prisons was last measured
at 27 percent—nearly double that of the general adult population (15
percent). To the credit of Prisons Service officials and non-governmental
organization (NGO) partners, in recent years the prisons have expanded HIV
testing, so that 57 percent of the prisoners we interviewed across all six
facilities we visited had been tested. However, access was uneven: Larger
prisons had significantly higher levels of testing than smaller prisons, and
men were more likely to be tested than women and juveniles. Access to anti-retroviral
therapy (ART) for HIV treatment has also improved among the prison population
in recent years, particularly in the larger prisons. However, proper treatment
is impossible in the absence of prison-based health services.

According to the prisoners we spoke with, sexual activity
between male inmates is common, including both consensual sex between adults, and
relationships where sex is traded by the most vulnerable in exchange for food,
soap, and other basic necessities not provided by the prison. PRISCCA, ARASA,
and Human Rights Watch also documented cases of rape between male prisoners. The
total ban on condoms, however, in the context of common sexual activity and
rape, creates a serious risk of HIV transmission and presents a major obstacle
to HIV prevention.

This report is the first analysis of prison health
conditions in Zambia by independent human rights organizations. In preparing
this report, PRISCCA, ARASA, and Human Rights Watch interviewed 246 prisoners,
eight former prisoners, 30 prison officers, and conducted facility tours at six
prisons throughout the central corridor of Zambia. The purpose of this research
was to understand health conditions and human rights violations in Zambian
prisons, and to provide recommendations for a future which respects the basic
rights and minimum standards due to prisoners.

Good prisoner health is good public health. Prisoners come
from and mostly return to the community, carrying infectious diseases from one
to the other. Prison officers are also daily exposed to the conditions and
health risks in prison and can expose their families and contacts outside of
prison. While certainly poverty and access to healthcare are issues in the
Zambian general population, the government nevertheless has an obligation to
ensure basic minimum standards for detainees and medical care at least
equivalent to that available in the general population, in order to protect
both prisoners’ rights and public health. Resource constraints
notwithstanding, the Zambian government has a binding and non-negotiable
obligation not to expose people to conditions of torture and cruel, inhuman, or
degrading treatment, which it currently violates when sending people to prison.

Contrary to international standards, convicted, unconvicted,
and immigration detainees—children and adults—are held together,
equally subject to the prisons’ grossly inadequate conditions. Detainees
in each of these categories, men as well as women, face particular challenges
in their confinement.

Prisoners who have yet to face trial—routinely held at
every facility with convicted prisoners in violation of international and
Zambian law—are held on remand for extended periods, exacerbating prison
overcrowding. Interviews with inmates, prison officials and NGOs found such
problems as police investigation failures, lack of bail, and lack of representation
for accused persons keep individuals unnecessarily, and often unlawfully,
incarcerated for extended periods of pre-trial detention. The large number of
remand prisoners is a result of failures in the criminal justice system as a
whole, including the Zambian judiciary, Police, and Prisons services. At Mukobeko
Maximum Security Prison, one prisoner told us that he spent three years and
seven months awaiting even an initial appearance before a magistrate or judge; another
prisoner, now convicted and living at Lusaka Central Prison, told us that he
had spent 10 years as an unconvicted prisoner awaiting resolution of his case. The
incarceration of unconvicted detainees is clearly a major contributing factor
to the prisons’ extreme overcrowding: At Lusaka Central Prison, 601 of
the 1145 inmates—more than half—are remandees. Overall, 35 percent
of the Zambian prison population is composed of remandees. Even given Zambia’s grossly inadequate prison
conditions, the current cost to the government of incarcerating remand
detainees unnecessarily for extended periods is not insignificant, and savings
could likely be generated by increasing the use of bail instead of pre-trial
detention.

Immigration detainees—including administrative
detainees held pending deportation—are frequently detained and await
deportation without due process, mingled with convicted and remandee prisoners.
Among the immigration detainees PRISCCA, ARASA, and Human Rights Watch
interviewed, only 38 percent had ever seen a magistrate or judge,
compared with 97 percent of non-immigration detainees. Many who were detained
appeared to have reasonable claims to legal status. Immigration detainees are routinely
told to pay for their own deportation and are held until they pay.

Children held in detention are entitled to
particular protections under international law. Children should be detained
only as a last resort, and for the shortest appropriate time; children
who are detained should be separated from adults. However, in Zambia, children
are routinely incarcerated for minor offenses, often after
criminal processes in which they have not had any legal representation. Held
together with adults (including adults incarcerated on charges of defilement of
a minor) at some facilities, detained children are exposed to the risk of rape.

Women detainees are entitled to specific protections under
regional human rights standards, but incarcerated women in Zambia do not have
their unique healthcare needs met. Women’s health services including
gynecological care and cervical cancer screening are non-existent. Pre-natal
services are absent or inadequate, and there is no HIV Prevention of
Mother-to-Child Transmission (PMTCT) program under the prison medical
directorate. The already nutritionally inadequate prison food is unchanged for
nursing or pregnant women.

Compounding these injustices and overcrowding is injustice
within the criminal justice system. The Zambian police and Drug Enforcement
Commission (DEC) enjoy broad powers under Zambian law, and police and DEC
officers reportedly arrest and hold numerous alleged family members, friends,
and innocent by-standards as “co-conspirators” when their primary
targets cannot be found. Such arrests, which may or may not comply with Zambian
law, are considered arbitrary arrests—and therefore unlawful—for
the purpose of international standards on the deprivation of liberty. Lack of
non-custodial sentencing, restrictions on the use of parole, and delays in
appeals further contribute to overcrowding.

Under international human rights law,
prisoners retain their human rights and fundamental freedoms, except for the
restrictions on rights necessitated by the fact of incarceration itself. States
are required to ensure prisoners a standard of health care equivalent to that
available to the general population, a commitment acknowledged by the Zambia
Prisons Service.

The Zambian government has repeatedly committed itself to uphold
the human rights of prisoners through its assumption of international and
regional obligations. As a state party to the International Covenant on Civil
and Political Rights, the Convention Against Torture, the International
Covenant on Economic, Social and Cultural Rights, the Convention on the
Elimination of All Forms of Racial Discrimination, the Convention on the
Elimination of All Forms of Discrimination Against Women, the Convention on the
Rights of the Child, and the African [Banjul] Charter on Human and
Peoples’ Rights and its protocol on the rights of women, Zambia has an
obligation to ensure that its criminal justice and penitentiary standards
comply with international and regional human rights standards, to ensure that
detainees are treated with appropriate dignity and full respect for their human
rights, and to prevent all forms of cruel, inhuman, or degrading treatment.

Clearly, resource constraints are a major consideration, but
greater priority on prison funding needs to be put at the national level and
greater support from international donors needs to be forthcoming if change is
to be effected. Some necessary reforms—particularly legal
reforms—are resource-neutral; those that aren’t are crucial to the
realization of the rights of prisoners and are the responsibility of both the
national government and international donors.

To address existing human rights violations in its prisons,
the Zambia Prisons Service should immediately reform prison disciplinary systems
to discontinue current abusive disciplinary practices, and end the use of cell
captains to carry out brutal punishments on behalf of prison officials. Prisoners should not be punished for sexual or other
kinds of intimacy, except in cases of rape.The Prisons Service should
immediately install a clinical officer at each prison to assess health and
review prisoner medical complaints. In the intermediate and longer term, the
Prisons Service—in collaboration with the Parliament and international
donors—should secure enough funding for the prison budget to ensure
conditions consistent with international standards and scale up prison-based
medical care.

Furthermore, in order to alleviate the failings in the
criminal justice system that exacerbate overcrowding and violate the rights of
prisoners, the Zambian Parliament, judiciary, Police Service, and Prisons
Service need to work together to decrease arbitrary arrests, increase the use
of bail, and reduce judicial delays. Significant effort should be made to scale
up the use of parole and non-custodial alternatives to incarceration. Every
prisoner, including child detainees, should be able to exercise their right to
have a lawyer of their choosing. Only with cooperation between these bodies,
and with the assistance of international agencies, donors, and NGOs, will the
rights of prisoners and the goal of prisoner rehabilitation be fully realized.

Zambia’s prison system is at a pivotal moment for
change to bring the conditions in its prisons in line with its international
and national commitments to prisoner health. The Zambia Prisons Service, in
conjunction with PRISCCA and other stakeholders, has itself recently completed
an audit of Zambia’s 53 standard prisons, research that included detailed
information on prison facility conditions and a list of prisoners at each
facility in need of special assistance. Having acknowledged the problems in the
prison system, conducted an internal audit, appointed a new medical director,
and granted access to human rights monitors, the Zambia Prisons Service has
shown a desire and openness to improvement. By building on the observations in
its own audit, those of outside human rights groups, and collaborating with Parliament,
the judiciary, the immigration service, the police, and international agencies,
donors, and NGOs, the Zambia Prisons Service has the opportunity to improve the
welfare of its prisoners, and to become a regional model in doing so.

Key Recommendations

For
Immediate Implementation

The President of Zambia should issue a
public statement identifying prison conditions and health as a national
crisis and should establish a high-level inter-ministerial task force to
urgently develop a national prison health plan

The Zambian Parliament should amend
the law to limit the powers to carry out sweeping, group arrests in violation
of international law currently enjoyed by the police and Drug Enforcement
Commission

The Zambian Parliament should address overcrowding
by taking steps to expand parole eligibility by amending the Prisons Act and
Prisons Rules

The Zambia Prisons Service and Ministry of
Home Affairs should prohibit the use of penal block practices, and discipline
staff and inmates for abuses against prisoners

The Zambia Prisons Service and Ministry of
Home Affairs should establish the presence of a clinical officer at each prison
who can judge prisoner health complaints and facilitate access to outside
Ministry of Health medical facilities

The Zambia Prisons Service and Ministry of
Home Affairs should provide condoms to all prisoners and prison officers, in
conjunction with education on harm reduction to increase condom acceptance

The Ministry of Justice should issue
guidelines for bail administration to encourage increased defendants’
instruction in bail rights and increased granting of bail, considering accurate
information about household incomes in Zambia

International agencies, donors, and NGOs
should integrate discussion of prison health into existing technical advisory
committees to the Zambian government

For Intermediate-Term
Implementation

The Zambia Prisons Service and Ministry of
Home Affairs should consistently separate children and adults, and convicted,
remand, and immigration detainees

The Zambian Parliament should allocate
funding for supervision of community-based sentences

The Zambian Parliament should repeal or
amend Sections 155, 156, and 158 of the Penal Code in order to decriminalize
consensual sexual conduct among adults, and implement gender-neutral laws to
protect adults and children from sexual violence and assault

International agencies, donors, and NGOs
should fund and supplement direct health service programs in prisons including
TB testing and treatment; women and children’s health; and nutrition
support

The Zambian judiciary and Ministry of
Justice should ensure all detainees, including those under 18, have access to a
lawyer of their choice

The Ministry of Health should develop a
detailed plan for the improvement of prison health services and conditions as
part of its National Health Plan 2011-2015

For Long-Term Implementation

The Zambian Parliament should secure and
international donors should assist with securing enough funding for the prison
budget to ensure conditions consistent with international standards. Funding
should be sought for facility renovation, upgrading water and sanitation
facilities, adequate food, the provision of basic necessities, and adequate
prison-based health services

The Zambia Prisons Service and Ministry of
Home Affairs should establish clear guidelines on the provision of prison-based
health services, and scale up those services to:

Conduct health screening of all prisoners
upon entry and at regular intervals

Provide TB screening to all inmates entering
prison, and all existing inmates, and ensure prompt initiation on treatment for
those with confirmed disease

Offer voluntary HIV counseling and testing
to all inmates entering prison and all existing inmates and prompt initiation
on anti-retroviral treatment

Establish clinics at each prison with a
consistent supply of essential medications and a minimum capacity to conduct TB
and HIV testing and treatment

Ensure access to antenatal services,
including PMTCT, early infant testing, and ART for infants

Methodology

This report is based on information collected during four
weeks of field research conducted by the Prisons Care and Counselling Association
(PRISCCA), the AIDS and Rights Alliance for Southern Africa (ARASA), and Human
Rights Watch in September-October 2009 and February 2010. The Zambian Ministry
of Home Affairs granted permission for access to six prisons and to conduct
confidential interviews with inmates and staff, with access provided by the
Zambia Prisons Service. Researchers interviewed 246 prisoners, eight former
prisoners, 30 prison officers in charge and officers, and conducted facility
tours at six prisons throughout the central corridor of Zambia. 232 of the
prisoners interviewed completed a survey providing information about the
prisoner’s incarceration history, medical care, and HIV/AIDS and TB
testing and treatment.

Researchers also interviewed 28 representatives from local
and international organizations working on prison, HIV/AIDS, and health issues,
and donor governments and agencies.

Researchers engaged repeatedly with Zambian government
officials throughout the course of this research. The research commenced with a
workshop, attended by the commissioner of prisons, officers in charge and
officials of the Zambia Prisons Service, to introduce the research and identify
key prison health concerns of prison officers and officials. Researchers also conducted
18 interviews with officials from the Ministry of Home Affairs, Ministry of
Health, Zambia Prisons Service, police and immigration services, the Drug
Enforcement Commission, the National HIV/AIDS/STI/TB Council, and the National
Human Rights Commission. Researchers toured Lusaka Central Prison, the prison
clinic, and the University Teaching Hospital accompanied by Dr. Chisela
Chileshe, the director of prison medical services. PRISCCA, ARASA, and Human
Rights Watch lodged a letter with the commissioner of prisons requesting the
Prisons Service’s Annual Reports and statistics on prison staffing,
deaths in custody, reports of those who are ill in custody, and reports of
assaults and disease in prison custody in accordance with Zambian law
requirements that such records be kept [see Appendix]. As of this writing, our
request had not been answered. PRISCCA, ARASA, and Human Rights Watch also
lodged a letter with the Drug Enforcement Commissioner requesting copies of
records or reports on the number and charges of individuals arrested,
convicted, and incarcerated in Zambia on drug-related charges. As of this
writing, that request had also not been answered.

In each prison visited, the research team requested from the
officer in charge a private location to conduct interviews with a cross-section
of prisoners held in that facility, including female prisoners, immigration
detainees, juveniles,[1]and pre-trial detainees. Priority was given to the inclusion of prisoners
from each category rather than proportional representation. Officers identified
prisoners who were then provided an explanation of the survey, asked if they
were willing to participate, and assured of anonymity in the final report.

Table 3: Prisoner
Characteristics

Interviews were conducted in English, French, Bemba, Nyanja,
and Tonga, with translation provided by PRISCCA members. Individuals
participating were assured that they could end the interview at any time or
decline to answer any questions without any negative consequence. The names of
all prisoners interviewed and quoted in this report have been changed to
protect their identity and for their security.

The average length of time prisoners we interviewed had
spent in prison varied widely, ranging from an average of less than one month
for adult females at Mumbwa Prison, to an average of 44 months for adult men at
Mukobeko Maximum Security Prison. The prisoners we interviewed across prisons
had an average age between 30 and 40, and most were of Zambian nationality,
though non-Zambian nationals were more common at Lusaka Central and Kamfinsa
prisons. Male prisoners had more frequently achieved secondary or higher
education than female prisoners. The percentage of married prisoners ranged
from 41 at Lusaka Central to 70 at Mwembeshi.

Table 4: Prisoner
Interviewee Demographics

Background

The Prisons of Zambia

Despite international and national legal commitments to
prisoner health, observers have noted in recent years that conditions in
Zambia’s prisons are grossly inadequate.[2] Zambia’s
prisons were built prior to 1964 to accommodate 5,500 prisoners.[3]
In October 2009, they housed 15,300—nearly three times official capacity.[4]
In 2005, when the total national prison population was 14,427, nearly 35
percent of those were remand prisoners awaiting trial (including 230 remanded
juveniles).[5]
Women constitute 2.6 percent of the total convicted prison population in
Zambia.[6]

Zambia has a total of 86 prisons throughout the country, 53
of them standard prisons and 33 open air/farm prisons. One of these facilities
is dedicated exclusively to juveniles, and one exclusively to women, though
juveniles are incarcerated with the adult population at other facilities
throughout the country, and women live in separate sections of additional
facilities throughout the country.

By law, the Zambia Prisons Service is established for the
management and control of prisons and the prisoners they hold.[8] International
law requires that penitentiary systems’ “essential aim” is
prisoners’ “reformation and social rehabilitation,”[9]
and Zambia’s system espouses the goals of both order and reform.[10]

Zambian law establishes minimum standards for medical care,
and requires that the officer in charge of each prison maintain a properly
secured hospital, clinic, or sick bay within the prison.[11] A
serious gap exists between these legal requirements and practice, with little
or no medical care available at most of Zambia’s 86 prisons. Only 15 of
Zambia’s prisons include health clinics or sick bays, and many of these
clinics have little capacity beyond distributing paracetemol.[12]
In February 2010, the Zambia Prisons Service employed only 14 trained health
staff—one physician, an administrative rather than a clinical role, one
health environmental technician, nine nurses, and three clinical officers[13]—with
11 prospective staff still in training.[14] “The ratio
is out of this world,” Dr. Chisela Chileshe, the physician in charge of
the prison medical directorate, concluded, referring to the ratio of medical
staff to the inmates under their care.[15]

While there are some Ministry of Health
medical staff seconded to work in the prisons, they are often present there
only a few days a week, and there is only one Ministry of Health physician who
visits the prisons.[16]Coordination between prison health officials and Ministry of
Health officials has been minimal. The National Health Strategic Plan
2006-2010, designed to lay out how to achieve national health priorities
through goals for government, health workers, cooperating partners, and other
key stakeholders, includes no mention of prisons.[17]

Donors have actively supported health initiatives in Zambia,
though relatively little of this assistance has gone to government or NGO-based
prison health initiatives thus far. For HIV/AIDS alone, in 2009 the United
States contributed over US$262 million and the Global Fund contributed over
$137 million to Zambia, with other major HIV/AIDS donors including the European
Union, Sweden, Denmark, Norway, the Netherlands, and the United Kingdom.[18]
In 2008, the National HIV/AIDS/STI/TB Council analyzed HIV/AIDS spending in
Zambia. That assessment listed no amount for aid to prisoners in 2005 and
$76,300 in 2006.[19]
Some NGOs have received grants for prison-based health work—for example,
in 2006 the Prisons Fellowship of Zambia in Lusaka and Ndola each received
$10,506 as Global Fund Sub-Recipients,[20]
the Go Centre/CHRESO Ministries, which provides HIV testing and treatment at
several prisons, is funded by the US President’s Emergency Plan for AIDS
Relief,[21]
and USAID funds an HIV prevention, treatment, care and support
(“SHARe”) program which operates in some prisons.[22]
Funding problems for both Prisons Service and Ministry of Health services will
be compounded by the fact that, as a result of a corruption scandal at the
Ministry of Health, Global Fund funding to Zambia has been halted pending an
audit.[23]

Funding to improve the prisons generally is inadequate.[24]
In 2010, the Zambian national budget was over 16 trillion Zambian kwacha ($3,376,810,000),
14.5 percent of which was financed through partners.[25]
The Zambia Prisons Service 2010 budget was 52 billion Zambian kwacha
($10,974,600).[26]
The Prisons Service has never been funded by the Ministry of Finance to its
requested amount.[27]
NGOs note that every year, the Prisons Service is the least funded of the
services under the Ministry of Home Affairs.[28]

Prison medical services particularly suffer from lack of
funding. Despite a comprehensive strategic plan on HIV/AIDS/STI/TB, according
to the Ministry of Home Affairs HIV/AIDS focal point person Gezepi Chakulunta, “we
haven’t done much on the strategic plan because of lack of
funding.”[29]
Dr. Chileshe explained that plans to expand prison health services were
likewise hampered by lack of funding. He has plans for a directorate which will
include a head office and prison-based services, a physician in each of the
country’s nine regions, a referral hospital for prisoners, and clinics in
all the prisons, but funding for such a system remains uncertain.[30]

Prison-based medical care under the medical directorate
(aside from seconded Ministry of Health employees and medications) comes out of
the prison budget (under the Ministry of Home Affairs), rather than the
Ministry of Health budget. In 2009, a budget for prison medical services did
not exist.[31]
For 2010, Dr. Chileshe reported that “my budget will be 200 million
kwacha [$42,210] per year ... about 16.6 million per month [$3,503] excluding
salaries....I do not have enough to do all that we want.”[32]
By contrast, to have a clinical officer and clinic at each of the 53 standard
prisons (still leaving 33 open air prisons without a Prisons Service clinic),
he said, would cost about 26 billion kwacha ($5,487,320).[33]

HIV and TB in Zambia and the
Prison System

While HIV prevalence among Zambian adults
is 15 percent,[34]
available evidence suggests that HIV prevalence in Zambian prisons is significantly
higher. A study conducted in 1998-99 in three Zambian prisons found a male HIV
prevalence of 27 percent, and a prevalence of 33 percent among female inmates.[35]
Based on these data, prevalence has until recently been routinely estimated at
27 percent of the overall prison population.[36]
HIV/AIDS has had deadly consequences in the prison population, among officers
and inmates: Between 1995 and 2000, an estimated 2,397 inmates and 263 prison
staff died from AIDS-related illnesses.[37]

In the general population, in 2004, the Zambian government
introduced free access to anti-retroviral therapy (ART) in the public health
sector. In June 2005, the government declared the ART service package
(including counseling, x-rays, and CD4 testing[38])
free of charge.[39]
The Zambian National HIV/AIDS Policy includes prisoners and commits to
providing HIV prevention information, voluntary counseling and testing upon
admission to custody, and detection and treatment programs to prisoners.[40]

Since its commitment to free treatment in the public health
sector, Zambia has been making progress in treating its HIV-positive
population. Between 2004 and 2007, the number of people on ART jumped from
20,000 to 151,000, an increase from seven percent coverage of those requiring
it to 46 percent.[41]
The estimated percentage of women living with HIV who received ART to prevent
mother-to-child transmission increased from 18 percent in 2004 to 47 percent in
2007.[42]
However, Zambian HIV/AIDS NGO representatives report that access to ART in
rural areas is significantly more limited than that in urban areas, and there
is also a sizable difference between medical infrastructure and personnel
availability between urban and rural areas.[43] Access or further
expansion is uncertain with the suspension of Global Fund grants, pending corruption
investigations.

Such a high HIV prevalence, coupled with poor prison conditions,
raises a significant risk of tuberculosis (TB) infection. As
well as being the most common opportunistic infection among people living with
HIV in Africa, TB is pervasive in southern African prisons because of
overcrowding, poor ventilation, and lack of prevention practices such as prompt
identification and treatment of persons with active TB.[44]A 2000-2001 study in 13 Zambian prisons for pulmonary TB among inmates
concluded that a high rate of pulmonary TB exists in Zambian prisons,
speculating that true prevalence rates may approach 15-20 percent, with
significant rates of drug resistance and multi-drug resistant TB[45]
(MDR-TB).[46]Indeed, with mortality rates as high as 24 percent,
tuberculosis is among the main causes of death in prisons in developing
countries.[47]Worldwide, TB is the “leading infectious killer for people living
with HIV”, responsible for an estimated 13 percent of AIDS deaths.[48]

In the general population, Zambia bears a heavy burden of
TB, with a prevalence of 387 cases of all forms of TB per 100,000 members of
the population in 2007 and 115 TB-related deaths per 100,000 members of the
population in that year.[49]
In 2009, there were 50,000 cases of TB throughout the country.[50] MDR-TB
comprised 1.8 percent of all new TB cases in 2007. Yet Zambia has also been
making progress in treating TB in the general population: Between 2000 and
2006, the coverage of Directly Observed Treatment, Short-course (DOTS) expanded
significantly.[51]
For new sputum smear-positive cases, between 1999 and 2007, the treatment cure
rate rose from 50 percent to 78 percent; the treatment success rate rose from
69 percent to 85 percent.[52]
However, difficulties in screening, diagnosing and treating various forms of
TB—particularly extra-pulmonary TB—continue to contribute to
difficulties in establishing an effective response to the disease nationwide.[53]

In the prison population, suspected prevalence rates are
very high, though reliable data do not exist.[54] The physician in
charge of the prison medical directorate reported that TB is the leading cause
of death in the prisons;[55]
he acknowledged that “the prisons are a breeding ground
for TB/HIV” and has recognized the impact of
prison conditions on the spread of TB.[56] The Zambia Prisons Service has reported a case infection
rate for TB of 5,285 cases per 100,000 inmates per year.[57]

At Mumbwa prison, a prison officer reported that with a prison
population of 354, only four prisoners had been tested for TB in the previous
year—and all four were found to be positive.[58]
High HIV prevalence compounds the dangers posed by TB: As the HIV/AIDS coordinator
at Lusaka Central prison aptly noted, “People with compromised immune
systems are vulnerable to TB. Ventilation is very poor at the prison. People
with HIV catch TB easily.”[59]

Zambia’s Obligations
Under International, Regional, and Domestic Law

The Zambian government is obliged under national and
international law to protect the rights of prisoners and those in its custody.

On the international level, Zambia is a party to core
regional and international human rights treaties. These include the
International Covenant on Civil and Political Rights (ICCPR), the Convention
Against Torture (CAT),[60]
the International Covenant on Economic, Social and Cultural Rights (ICESCR),[61]
the Convention on the Elimination of All Forms of Discrimination Against Women
(CEDAW),[62]
the Convention on the Rights of the Child (CRC),[63]
the Convention on the Elimination of All Forms of Racial Discrimination
(ICERD),[64]
the African Charter on Human and Peoples’ Rights,[65]
and the Protocol to the African Charter on Human and Peoples’ Rights on
the Rights of Women in Africa.[66]
These treaties provide for the protection of basic civil and political rights
and also ensure specific guarantees relating to the treatment and conditions in
custody for those deprived of their liberty. These treaties are supplemented by
instruments specific to the treatment of those in detention, discussed below.

On the national level, key protections are laid down in the
Constitution and The Prisons Act and Rules of the Laws of Zambia.

Prisoners’
Rights

Under international human rights law,
prisoners retain their human rights and fundamental freedoms, except for such
restrictions on their rights required by the fact of incarceration; the
conditions of detention should not aggravate the suffering inherent in
imprisonment,[67]
except as necessary for justifiable segregation or the maintenance of
discipline.[68]This rule cannot be dependent on the material resources
available to the national government in question.[69]

The most fundamental protection for prisoners is the
absolute prohibition on torture. As well as being a well-established norm of
international law by which Zambia is bound, the prohibition is also reflected
in the Zambian Constitution, and in several of the human rights treaties to
which Zambia is a party.[70]
The ICCPR and the CAT prohibit torture and cruel, inhuman, or degrading
treatment or punishment without exception or derogation. Article 10 of the
ICCPR further requires that “[a]ll persons deprived of their liberty
shall be treated with humanity and with respect for the inherent dignity of the
human person.”[71]
The African Charter on Human and Peoples’ Rights also protects every
individual’s human dignity and prohibits “all forms of exploitation
and degradation,” including slavery, torture, and cruel, inhuman or
degrading punishment and treatment.[72]

The CAT defines torture and cruel, inhuman or degrading
treatment or punishment to include not only acts committed by public officials,
but also acts committed with their acquiescence.[73]
Thus, prison officials are responsible for all abuses in prison committed by
inmates with their acquiescence.

Numerous international instruments provide further guidance
on the protection and respect of human rights of persons deprived of their
liberty. The most comprehensive such guidelines are the United Nations (UN) Standard
Minimum Rules for the Treatment of Prisoners. Other relevant instruments
include the Body of Principles for the Protection of All Persons under Any Form
of Detention or Imprisonment and the Basic Principles for the Treatment of
Prisoners.[74]

International law and standards guarantee imprisoned
children special protections. The Convention on the Rights of the Child
protects children from torture or other cruel, inhuman or degrading treatment
or punishment, and provides that children deprived of their liberty shall be
treated with humanity and respect for the inherent dignity of the person.[75]
Detention of a child “shall be used only as a measure of last resort and
for the shortest appropriate period of time.”[76]
For those children who are detained, they are to be separated from adults.[77]
The United Nations Standard Minimum Rules for the Administration of Juvenile
Justice lays out additional protections for children deprived of their liberty.[78]

Women detainees also benefit from special legal protections.
Regional law provides that women in detention should be held in an environment
“suitable to their condition” and ensures their right to be treated
with dignity.[79]
The Southern African Development Community Protocol on Gender and Development,
which Zambia has signed, commits states by 2015 to “ensure the provision
of hygiene and sanitary facilities and nutritional needs of women, including
women in prison.”[80]

The Right to Health

All people have a right to the highest attainable standard
of health.[81]The International Covenant on Economic, Social and Cultural Rights requires
states parties to take steps individually and through international cooperation
to progressively realize this right via the prevention, treatment, and control
of epidemic diseases and the creation of conditions to assure medical service
and attention to all.[82]
African regional law also supports the right to health.[83]
“Progressive realization” demands of states parties a
“specific and continuing obligation to move as expeditiously and
effectively as possible towards the full realization of [the right].”[84]The concept of available resources is intended to include available
assistance from international sources.[85]

States have an obligation to ensure medical care for
prisoners at least equivalent to that available to the general population.[86]
According to the Economic, Social and Cultural Rights Committee, the monitoring
body for the Covenant on Economic, Social and Cultural Rights, “States
are under the obligation to respect the right to health by, inter alia,
refraining from denying or limiting equal access for all persons, including
prisoners or detainees, minorities, asylum seekers and illegal immigrants, to
preventive, curative and palliative health services.”[87]Furthermore, the ICCPR requires that governments should provide
“adequate medical care during detention.”[88]
The Committee Against Torture—the monitoring body of the Convention
Against Torture—has found that failure to provide adequate medical care
can violate the CAT’s prohibition of cruel, inhuman or degrading
treatment.[89]

Thus, international human rights law explicitly protects
prisoners against discrimination in receiving health care. The Zambia Prisons
Service has acknowledged this commitment: “It has been decreed in various
Charters, Conventions and International Instruments that all prisoners, irrespective
of nationality, race or gender are entitled to the same quality of health care
as that available outside jail.”[90]

Prison Conditions and
Consequences for Detainees’ Health

These conditions defeat the purpose of rehabilitation. You
cannot subject people to this and expect them to reform. It’s so tough
and rough that it is survival of the fittest. A person who walks in a good
person, before serving one fourth of their sentence, they become a beast. They
leave deformed. These conditions destroy us mentally and physically.

–
Winston, 35, Mukobeko Maximum Security Prison, September 29, 2009

All prisoners are due respect based on their inherent
dignity as human beings.[91]
The requirement to take positive steps to ensure minimum guarantees of humane
treatment for persons within their care[92] implies an
obligation on states “to fulfil and protect the various
human rights of detainees, above all their rights to food, water, health,
privacy, equal access to justice and an effective remedy against torture and
other human rights violations, [which] derives from the simple fact that
detainees are powerless.”[93]
Current conditions in Zambian prisons violate international law and standards
on prisoners’ welfare.

Overcrowding

The way they used to pack slaves in the ship, that is
how we sleep.

– Kenneth,
37, Mukobeko Maximum Security Prison, September 30, 2009

Zambian prisons are among the most overcrowded prisons in
the world, and were at over 275 percent of capacity in October 2009.[94]
The government of Zambia itself has admitted that “Zambian prisons have
for a long time experienced enormous problems” including “poor
state of infrastructure, congestion, poor diet, poor health care, poor
sanitation and water supply and a general lack of rehabilitation facilities,”
and that existing prison population levels “cannot be sustained by the
current prison infrastructure.”[95]
International monitors have also repeatedly recognized that overcrowding in
Zambian prisons is unacceptable, as are the health and human rights consequences
of this overcrowding.[96]

At the time of our visit, Mukobeko Maximum Security Prison,
a facility built in 1950 for a capacity of 400, housed 1731 inmates[98]—433
percent of its capacity. Lusaka Central Prison, a facility built in 1923 with a
capacity of 200[99]
housed 1145[100]—573
percent of capacity. Mwembeshi, a farm prison opened with a capacity of 55
inmates, housed 342—622 percent of its capacity—on the day of our
visit.[101]
At Mukobeko, 140-150 inmates sleep in cells measuring eight meters by four
meters,[102]
which inmates reported were designed for 40.[103] At Choma, 76-78
inmates sleep in each eight meter by four meter cell.[104]

International standards require that prisoners be provided
with a separate bed, and separate, sufficient, and clean bedding. These
requirements were not met in any of the facilities visited by PRISCCA, ARASA,
and Human Rights Watch.[105]

At many prisons visited, overcrowding is often so severe
that inmates cannot lie down at night. J. Kababa, officer in charge at Lusaka
Central, confirmed that at that facility: “they sleep in shifts. Because
of the congestion, not all can sleep at once. Some sleep, some sit. They take
turns to make sure that others get a chance.”[106] He
elaborated: “They are not sleeping, they are just squatting. Instead of
resting in the night, they come out tired.”[107]
Felix, 43, an HIV-positive remandee at Mukobeko, reported that “we have
no space. There is not even enough space to lie down. We must sit, packed in
like bags.”[108]
Detainees at Mukobeko, Mumbwa, and Mwembeshi reported that they sleep on their
sides, up to five on a mattress, unable to turn over.[109]

Officers recognized the pain experienced by inmates held in
such overcrowded conditions. The social welfare worker at Lusaka Central Prison
noted: “There is terrible suffering when you see them at night.”[110]
“I am not happy to keep people in these inhumane facilities,” the
offender management officer at Mukobeko, admitted.[111]

Over and over again, inmates reported the horrific
overcrowding they face every night in their cells, describing the bodies of
inmates in the cell as “squeezed like logs in a pile,”[112]
“packed like sacks,”[113]
or “like bodies in a mortuary,”[114] “like fish
in a refrigerator,”[115]
or simply “packed like pigs.”[116] Albert, 30, a
remandee at Lusaka Central told PRISCCA, ARASA and Human Rights Watch:

We are not able to lie down. We have to spend the entire
night sitting up. We sit back against the wall with others in front of us. Some
manage to sleep, but the arrangement is very difficult. We are arranged like
firewood.[117]

Such overcrowding leads to terrible, repeated suffering,
night after night. As Rodgers, age 42, a remandee at Lusaka Central said,
“we are being tormented physically. The way we sleep. If you put more
pigs in a room for a night than can fit, in the morning you would find all the
pigs are dead. These are the conditions we are in.”[118]

Packed together in their cells from four p.m. to six a.m.
nightly, illness spreads rapidly among inmates: The medical officer at Choma
reported that the most common health problems are respiratory infections,
diarrhea, and skin conditions and rashes.[119] Prisoners across
facilities reported frequent rashes as a result of close bodily contact. As
immigration detainee Jean Marie, age 28, put it, “we are sweating at
night on the floor; we don’t know what illness we have but we pass them
back and forth.”[120]

The risk of TB transmission is high. Sick and healthy are
routinely mixed together, and multiple inmates reported frequent coughing.[121]
International standards require proper ventilation to meet the requirements of
health and require that windows be large enough to allow the entrance of fresh
air.[122]
However, ventilation requirements are not met at Zambian prisons. Several of
the prisons we visited lacked adequate ventilation, and had only air vents.[123]
“We are all breathing the same confined air, contributing to all airborne
diseases,” Hastings, 32, told us.[124] Esther, 47, confirmed:

Ventilation is very poor. I have very small window and cell
captains block windows with their shoes, etc. and in this season it is so bad,
some people faint in the night. In the last month, five times. When we are
full, which is at least once a month, we have to sleep sitting up.[125]

International law requires that accused persons and prisoners
held on non-criminal charges be kept separate from the convicted and treated
separately; that adults and children, and men and women also be separated.[126]
Zambian law on the books is in line with most of these standards. However, in
practice, detention practices can be different.[127] Men
and women were separated at all of the facilities PRISCCA, ARASA, and Human
Rights Watch visited, and women guarded only by female officers. However, our
research found that, apart from separation of male and female detainees, all
categories of prisoners were packed together, in violation of international
standards. Convicted, unconvicted, and immigration detainees were held together
at all facilities, including non-criminal immigration detainees (among them
asylum seekers) held solely on administrative rather than penal grounds,
pending their deportation.

Children were not separated from the adult population at the
facilities we visited that included child inmates. Patrick Chilambe, the
officer in charge at Choma, confirmed that all prison populations, except for
males and females, are routinely mixed;[128] “as a
father it pains me,” he told us, that children do not have their own
facilities—“we need to build a separate area for juvenile
offenders.”[129]
Kabinga, 17, reported that we “are not happy to share the same cell with
adults and have complained to prison management, but our complaint has been
ignored.”[130]
Peter, a teenager, reported being threatened by other inmates if he revealed
the combined sleeping arrangements: “We sleep with the adults, but they
told us to say we sleep in a juvenile cell. If we don’t say we sleep in a
separate cell, they will beat us. We are given punishment when we start
talking. But we are scared we might die here.”[131]

Food and Nutrition

People are very, very hungry. It is difficult to
rehabilitate someone when he is starving.

– Clement, 28, Mukobeko Maximum Security Prison,
September 30, 2009

The most universal complaint we heard about prison
conditions—from nearly every prisoner at every facility we visited—involved
the insufficiency and low quality of the food. The food was described by
prisoners as “not fit for human consumption,”[132]
“food in name only,”[133]
and “fit for pigs.”[134]
“They really are not getting enough food,” the chaplain at Mukobeko
admitted; in fact, “[they are] starving. They always eat something, but
it can be a struggle.”[135]

Particularly harsh conditions of detention, including
deprivation of food, constitute inhuman conditions of detention in violation of
the ICCPR.[136]
International standards require that prisoners be supplied with “food of
nutritional value adequate for health and strength, of wholesome quality and
well prepared and served.”[137]
This standard has been cited with approval by the UN Human Rights Committee
when examining the minimum standards that a state must observe for those
deprived of their liberty, “regardless of a state party’s level of
development.”[138]
International standards further protect the rights of children deprived of
their liberty to suitable food of sufficient quantity and quality to satisfy
dietetic, health, and hygiene requirements.[139]
Zambian law prescribes a dietary scale that includes meat or fish, cocoa,
sugar, salt, fresh fruits in season, and fresh vegetables.[140]
Neither international law and standards nor Zambian law requirements are met by
the diet provided to prisoners.

Food consists usually of rice at breakfast, followed by a
single meal[141]
of maize meal and kapenta (tiny dried fish commonly eaten in Zambia) and/or
beans at four p.m.. Despite the fact that farm prisons grow tomatoes and other
vegetables, the occasional cabbage was the only government-provided vegetable,
and most of the vegetables grown on the farms are sold to generate prison
income.[142]
Cruelly, inmates must therefore toil to produce vegetables that they virtually
never have the opportunity to eat, only to see them sold off and the profits
disappear into the prison system. The Zambia Prisons Service HIV and
AIDS/STI/TB Strategic Plan (2007-2010) has noted that “the practices of
diverting food from prisons or selling crops where the proceeds do not revert
back to Prisons Service must be stopped.[143]
“Vegetables?” asked Winston, 35, “It’s like vegetables
don’t even exist. They sell the stuff from the farm; we don’t ever
see it.”[144]
The quantity of meals was reported by prisoners across facilities and confirmed
by the officer in charge at Mumbwa to be approximately 400 to 450 grams of
maize meal per day (400 grams of maize meal is equivalent to roughly 1,400
calories[145])—in
addition to small quantities of beans and/or kapenta.[146] George
Sikaonga, the officer in charge at Mukobeko, though, claimed that the issue, as
per the dietary school, was 900 grams of maize meal per day.[147] Meals
were widely considered insufficient and many prisoners reported a constant
feeling of hunger.[148]
“I go to bed hungry,” George, 44, an immigration detainee at
Kamfinsa, told us.[149]
Frederick, 23, an inmate at Mwembeshi farm prison, said that “we are
starving by the time we eat and it is not enough after all day of work.”[150]

Inmates and prison officers at several prisons reported that
prisoners were routinely denied food. Inmates at farm prisons said that these
facilities often ran out of food, leaving some inmates with nothing to eat.
Johnston, 41, a remandee at Mumbwa, told us that remandees only eat after
convicts, “so if it is all gone, we don’t eat anything. This
happens regularly.”[151]
Robbie, 33, an inmate at Mwembeshi farm prison, reported “we have a
shortage of food. When we are short, we have to sleep without eating anything
until tomorrow. Some nights we eat nothing. When we are short, we just sleep
like that. It happens once a week, sometimes twice a week.[152]
Furthermore, Adam, 34, a remandee at Mumbwa, reported that because the prison
has no electric cookers, “When it rains we can’t use the firewood.
We eat nothing on those days. When we can’t cook, we don’t eat.”[153]
The officer in charge at Choma said that because of firewood shortages, cooking
and serving meals was sometimes done only once a day.[154]

Poor nutrition leads to numerous health problems. Dr.
Chileshe confirmed that malnutrition is a serious problem throughout the prison
system.[155]
The medical officer temporarily stationed at Mukobeko, who has been with Zambia
Prisons Service for nine years, noted that food provided to prisoners is inadequate
and unvaried, with the result that some prisoners become malnourished;
approximately seven of every 20 medical cases he screens point to malnutrition.[156]
The medical officer at Choma prison also confirmed that she found inmates to be
malnourished.[157]
Inmates reported that the poor quality of food and water led to persistent
diarrhea[158];
one reported dental problems as a result of the stones mixed in with the food,[159]
and another reported that he couldn’t see properly as a result of
malnutrition.[160]

The lack of nutritional diversity in prisoners’ diet
may be creating serious and life-threatening health conditions: PRISCCA, ARASA,
and Human Rights Watch heard repeated reports of swollen legs and feet,[161]
symptoms which are consistent with the nutritional deficit disorder “beri
beri.”[162]
Francis Kasanga, the deputy officer in charge at Mukobeko, reported that in winter
(July) 2009, as many as seven inmates had developed swollen legs and died
shortly thereafter. An investigation was conducted and “several doctors
recommended the introduction of a special diet, including fruit for the
affected, and the problem cleared after this intervention.”[163]

There is no special diet for pregnant women[164]
or for women who are nursing.[165]
Despite international standards calling for special provision for children
incarcerated with their parents[166]
and the legal provision that, subject to the commissioner’s conditions,
“the infant child of a woman prisoner may be received into the prison
with its mother and may be supplied with clothing and necessaries at public
expense,” and may stay up until age four,[167]
there is no food at all allocated to the children under age four who live with
their mothers in prison facilities; they are expected to share out of the
portion of the mother.[168]
In situations where women are unable to breastfeed, the prison does not offer
infant formula. Agnes, 25, an inmate living with her nine month-old baby boy,
informed us:

My child is not considered for food—I give my share
to the baby (beans and kapenta)—we eat once a day. I am not given any
extra food, and no special diet for the child. I am simply able to make some
porridge for him out of my nshima [a cornmeal porridge]. The baby has started
losing weight and has resorted to breast milk because the maize meal is not appetizing.[169]

The officer in charge at Lusaka Central echoed these
concerns: “I get no budget for the children’s food, they must eat
their mothers’ food. They are hungry a lot.”[170]
Tasila, 24, a pregnant inmate, expressed concern about how she would keep her
child fed, clothed, and in good health.[171] Annie, 33, an
HIV-positive female inmate, told us that the she could not get extra food for
her child, even from church donations, because the “cell captains and
officers contrive to take donations of food and goods brought by the church.
There is nowhere to go and complain.”[172]

As a result of chronic food shortages, food has become a
commodity that is traded to the most vulnerable in exchange for sex and labor.
As Willard, 25, put it, “Food is used as power. Those who have relatives
who bring them food are powerful in prison, those of us without relatives are
weak.”[173]

Orbed, 26, described to us how inmates come to trade sex for
food:

Food is a major problem. The quantity and quality are both
poor. It is not enough to sustain one’s life in here. We lose weight, we
are enslaved—all because of food. Those who are able to afford food can
enslave others. They say, “I will give you whatever you want for food if
you sleep with me,”—it happens a lot.[174]

Lawrence, 33, confirmed this practice:

Those who have been here much longer get more food, and the
lion’s share of everything. For those who come late, they must give
services in exchange. It is very common, especially for those who do not
receive any help from their families. They are the victims. The food we are fed
with is not food that someone can live with. So people tend to give in to such
practices if they are less privileged.[175]

Prisoners speaking with us recognized that sex can spread
HIV:

I have seen [sexual activity] happen all the time where
mostly the lifers, who have nothing to lose, will entice new and vulnerable
inmates to sodomy with food and cooking oil. Then they get HIV and when they
get out they infect their families. Or they die. I have had several friends catch
and die of HIV that way.[176]

Access to Potable Water and
Basic Hygiene

It tastes foul, but we drink it.

– Annie, HIV-Positive
Inmate, Lusaka Central Prison, October 4, 2009

The UN Standard Minimum Rules on the Treatment of Prisoners
specify that sanitary facilities shall “enable every prisoner to comply
with the needs of nature when necessary and in a clean and decent manner”
and furthermore that “[a]dequate bathing and shower installations shall
be provided so that every prisoner may be enabled and required to have a bath
or shower, at a temperature suitable to the climate, as frequently as necessary
for general hygiene according to season and geographical region.”[177]
Sanitation and water facilities in Zambia’s prisons do not meet
international standards and indeed violate prohibitions on inhuman and
degrading treatment. They also pose a major health risk.

Toilets are insufficient in number and are filthy; in some prisons
they consist only of a hole in the ground and at others simply a bucket.[178]
At Mwembeshi, inmates reported that there were no toilet facilities at all in
the cells, and a bucket was used overnight. The lack of a sewer system, the
officer in charge concluded, is “dehumanizing.”[179]
What outmoded and insufficient sewer systems do exist are constantly backing
up—all of the pipes of the Mukobeko sewer system, built in 1957, are
constantly blocked.[180]
At that prison, 10 outdoor toilets are shared by more than 1,000 inmates. Paul,
33, at Mukobeko, said, “you pray for your friends not to use the
loo.”[181]
“You have to plan in advance because there is a long queue,”
Daniel, 39, a “lifer” at Mukobeko, pointed out. “You can wait
for hours,”[182]
leading to fights between inmates.[183]
In the cells at Mukobeko, with one toilet for 140-150 inmates, “we queue
from when we are locked up, straight through until the morning.”[184]
Anderson, 35, an inmate at Choma, told us that there were two toilets for 150
inmates on his side of the prison, which overburdened the system to the extent
that “the toilets are always overflowing as people have diarrhea all the
time.”[185]
At Lusaka Central, female inmates reported that the two toilets in each cell
are reserved for urination: “If we excrete for any reason...we were told
we would be punished by the cell captain,”[186]
–“we must get permission from cell captain to poop when
necessary.”[187]

Inadequate toilet and bathing facilities pose particular
problems for disabled inmates. Chrispine, 46, a remandee on crutches with one
leg amputated, told us that it was particularly hard for him to use the hole in
the ground for a toilet,[188]
a difficulty confirmed by other disabled inmates.[189]
“I find it difficult to balance, jumping over my colleagues in the cell
to the toilet,” one explained.[190]

Additionally, water sources at some facilities are
disturbingly close to sanitation outflows.[191] As Kalunga, 29, reported,
“there is one bowl and pump for water, right next to the pit for trash,
which is right next to the pit toilets.”[192] At
Mwembeshi, the offender management officer told PRISCCA, ARASA, and Human
Rights Watch that “the water table is low, close to latrines. The
technician told us we need more chlorine which we don’t often
have.”[193]
Inmates at multiple facilities described drinking water as unclean.[194]

Furthermore, despite international standards dictating that drinking
water be available to every prisoner whenever he or she needs it,[195]
water availability is subject to shortages at many of the prisons, in some
cases because the water bill is not paid,[196] water is rationed[197]
or during electrical shortages.[198]
At Mukobeko, the offender management officer reported that the water supply is
clean but subject to erratic supply.[199] A prison officer
at Mukobeko told us that he has seen fighting among the inmates “many
times in accessing water.”[200]
Water shortages lead to the use of unclean water: “There is tap water but
we go to a stream to fetch water when we get none—none of it is treated,
it does not look clean.”[201]

Bathing facilities at some prisons are squalid. At
Mwembeshi, the bathing area is a muddy grass structure with no drainage[202]
and prisoners reported sharing buckets used for bathing.[203]
One inmate reported that they even reuse the same containers for bathing which
are used as toilet facilities in the cell at night.[204]

A possible consequence of such poor water quality and sanitation,
diarrheal disease is common among inmates. At Mwembeshi, the offender
management officer informed us that poor hygiene resulting from a lack of
toilets with water, and the use of buckets, facilitates diarrhea.[205]
Inadequate water quality and sanitation also can have additional, deadly
consequences for inmates: Adam, 34, a remandee, told PRISCCA, ARASA, and Human
Rights Watch, “the remandees are told to pick up the toilet tissues after
the night and clean up the area in the cell. This is without gloves, it spreads
diseases. There was a cholera outbreak a while back in cell three, [which made]
15 inmates [sick].”[206]
Unclean bathing facilities also lead to illness. In the ablution block, Moono, a
teenager at Lusaka Central, told us, “we end up contracting skin
diseases, and there is no proper water.”[207]

The Prisons Service does not provide basic necessities to
prisoners, and they are left instead to rely on family members, church
donations,[208]
or an exchange of sex or labor in order to obtain soap, razors, sanitary pads,
and items essential to proper hygiene. International standards require that
prisoners shall be provided with toilet articles necessary for health and
cleanliness, as well as razors.[209]
Zambian law provides that, if an unconvicted prisoner does not provide himself
with food and clothing, “he shall receive normal prison food, clothing,
and other necessaries”[210]
and that convicted prisoners receive these essentials. Yet such articles are
not provided. As Catherine, 38, described,

The prison does not provide us with soap, toothpaste, or
sanitary pads. If others don’t bring them for us, we have nothing. There
are lots of people with no relatives here. They have nothing....Some people
have no relatives—if you have no food, you are nobody in this place. You
can trade a cup of sugar for work.[211]

The unavailability of soap leads to poor hygiene: As the
HIV/AIDS coordinator at Lusaka Central reported, “hygiene is a big
problem—no toothpaste, soap, clean clothing, and mattresses are not
clean. There are not enough blankets, and no sheets—prisoners get cold.
They have no spares, so they cannot wash them.”[212] Inmates
routinely rely on shared razor blades,[213] or used razor
blades,[214]
very high risk behavior that promotes transmission of Hepatitis and HIV.
Additionally, inmates are not provided with basic cleaning materials such as
gloves and disinfectant in order to clean the latrines or toilet buckets.[215]

International standards require that prisoners be issued
separate and sufficient bedding that is “clean when issued, kept in good
order and changed often enough to ensure its cleanliness.”[216]
Yet in Zambia, mattresses and blankets are filthy and go for months without
being washed,[217]
in violation of international standards. As Jacob, 26, an inmate at Mwembeshi,
told us, “the blankets, they are not clean. Since I came, they have not
been cleaned. Someone told me they have not been cleaned since 2005. There are
lice and dust in all of them.”[218] Vermin, lice, and
cockroaches are commonplace. Indeed, at Mwembeshi, another inmate, 26, reported
that “one captain does not let people kill the lice—it is just to
be mean and mock them.”[219]
Mary, 27, who sleeps by the storeroom at Lusaka Central, had insects enter her
ear in the night, and she had to be taken to the hospital.[220]

Uniforms are not provided to remandee prisoners, and
clothing provided to convicts is grossly inadequate.[221]
Female inmates are given uniforms designed for male inmates.[222]
Some of the inmates at each prison are entirely without shoes; others wear only
a single shoe. Others wear only half a uniform. The officer in charge at Choma
confirmed that while convicted prisoners are meant to be provided with one
prison uniform, the uniforms have run out, and often uniforms are taken from
older convicts to give to the new.[223]
Marlon, 17, in rags, noted simply “I have no proper clothes.”[224]
“Some people are walking naked, with no uniforms,” Reynard, 35,
observed.[225]
With only one set of clothing, inmates are forced to wear their uniform at all
times, even when wet.[226]
Mwape, 47, at Mukobeko, declared, “I have only one torn t-shirt, one old
short, and a pair of sandals to survive on the remaining 11 years of my 17 year
sentence.”[227]
Mwisa, 29, an inmate at Choma, expressed the toll that inadequate clothing
takes on the psyches of inmates: “We have no coats in winter, and people
fall ill. It’s a matter of health, but also of dignity. How can one be
dignified when begging for clothes?”[228]

Mosquito nets are not provided, despite frequent cases of
malaria, and only a few personally owned nets were present at some of the
prisons we visited. Sylvia, age 70, informed us that in her cell, “we
have two major problems: One, plenty of mosquitoes, and two, no nets.”[229]

Rape

Studies have documented the occurrence of sexual activity
inside Zambian prisons,[230]
and even the former president has acknowledged this fact.[231] Overcrowding
in prisons has been shown to contribute to sexual violence.[232]
Our findings suggested a high prevalence of sexual activity between male (but
not female) inmates, including consensual sex between adults and the adult
relationships described above in which sex was traded for food. PRISCCA, ARASA,
and Human Rights Watch also heard reports of rape. Sexual activity was reported
at Mukobeko, Kamfinsa, and Lusaka Central prisons, and less frequently at
Mumbwa, Mwembeshi, and Choma prisons.

Although there is no general definition of rape in
international human rights law, rape has been authoritatively defined as
“a physical invasion of a sexual nature, committed on a person under
circumstances which are coercive.”[233]
Under Zambian law, rape is a gendered crime and may only be committed against a
woman. Sexual activity with children under age 16 constitutes defilement under
Zambian law.[234]
In Zambian prisons, children are frequently forced into sexual relationships
constituting rape, particularly when they are held with adult prisoners. At the
time of our visit to Mukobeko, three juveniles were held in a cell with three
adults— two of the adults in the cell were in prison on charges of defilement
of a minor.[235]

Chris, 17, reported that:

I have witnessed sexual abuse. One of the older inmates who
was put into our cell to sleep at night started showering my cellmate, a
juvenile, with gifts. He promised him money in return for sexual favors. My
friend wasn’t happy, and neither did he consent. But the other imposed
himself by buying him off with gifts, and saying that there was 100,000 kwacha
[US$21] waiting for him “at the reception”. When the older inmate
finally approached him sexually, my friend was intimidated, but managed to
shout and attracted the attention of the other juveniles. Unfortunately we
reported it to the officer on duty at night, and he promised to address it the
next day, but he didn’t. The cell captain intervened, though, and removed
the man, putting him into one of the other cells....Do I feel safe? No, I
don’t feel safe.[236]

David, a teenager at Lusaka Central, reported that “I
haven’t physically been abused, because I know the system, and avoid
enticements. But my more vulnerable friends fall prey. Once you eat the food,
they reprimand you, say you have no choice. I have seen it happen. It pains me
to see the pain they undergo as juveniles.”[237]
Moono, a teenager at Lusaka Central, concluded: “Mainly the juveniles are
very vulnerable. As young people coming into prison, we are full of fear. The
convicts take advantage of us by providing us with food and security. We enter
their dragnet, but by the time we discover this it is too late.”[238]

Sometimes when you are sleeping someone gets under you.
He’s already in your anus. Others wake up, and catch that man....They are
brought before the authorities. Sometimes they overlook it, or the officer in charge
can take you to the courts of law.[239]

We found, however, that significant denial among the
officers exists as to the occurrence of sexual activity: the officer in charge
at Mukobeko informed us that no prisoners were engaged in sexual activity to his
knowledge,[240]
but the deputy officer in charge at Mukobeko admitted that he “had
learned of fights between inmates of prisoners fighting over sexual and
romantic partners.”[241]
Furthermore, a prison officer at Mukobeko told us that he received roughly
three reports a month of sexual activity and that “captains are empowered
to attend to this.”[242]
At Kamfinsa, Patrick Mundianawa, the officer in charge, said that there is
“almost no sexual activity at the prison,” only attempts.[243]
At Lusaka Central, the officer in charge admitted that “there is a small
amount of sexual activity in the prison. When it happens, cell leaders report
and we investigate. We rush the victim to the hospital for physical exam. If it
is confirmed, the aggressor is taken to court. We always punish someone because
it can’t be acceptable as if we did that it would get out of hand.”[244]
“I don’t know, I haven’t heard any complaints,” the
officer in charge at Mumbwa demurred,[245] but the
deputy officer in charge, D. Mulenga, told us that he was aware of cases of
consensual sex.[246]
The officer in charge at Choma reported that there was no sexual activity in
the prison currently.[247]

The Availability and Quality
of Medical Care

International law dictates that prisoners be provided with
health care at least equivalent to that available in the general community.[248]
Health care currently provided in Zambian prisons falls far short of
international standards. TB and HIV present specific challenges.

Tuberculosis

TB
Transmission

The conditions at each prison visited by PRISCCA, ARASA and
Human Rights Watch—combining overcrowding, minimal ventilation, and a
significant immuno-compromised population—are ripe for the quick spread
of TB, confirmed by suspected high prevalence. As noted above, a 2000-2001
study in 13 Zambian prisons for pulmonary TB among inmates concluded that a
high rate of pulmonary TB exists in Zambian prisons, speculating that true
prevalence rates may approach 15-20 percent;[249]the
Zambia Prisons Service has reported a case infection rate for TB of
5,285 cases per 100,000 inmates per year.[250] High turnover
exists in the prison population, so spread of TB to the general public by released
inmates is also a significant risk.[251]
As an officer at Mwembeshi noted, “The cells are meant to accommodate 10
but they hold 135. The men don’t sleep well. If one has TB, four or five
have it. Before it is identified, it has already spread.”[252]

Interviews with inmates and prison officers established that
there exists a strong awareness of the possibility of transmission, and a deep
fear of both contracting TB and spreading it within the community.[253]
As one prison officer at Kamfinsa said, “we need to care for and prevent
some diseases like TB. If so many people are sick, the officers can be
affected. We necessarily worry about getting TB at our work. If I am sick, I
can transfer it to my family. It worries us.”[254] According
to an inmate, “the ventilation is not good. There is coughing and TB in
the cells. It takes time to be detected, but by the time they detect it, the TB
will have spread to many of our fellows. It keeps us worried.”[255]
Dr. Chileshe confirmed: “They say, ‘you’re going to
Chimbokaila [Lusaka Central Prison]? It’s a death sentence.’ Not
because they are afraid you will be given beatings, but because of TB. They
know the conditions are bad.”[256]

Children incarcerated at Mukobeko have shared living
quarters with the TB isolation cell. The children fear TB
patients—“I am worried I will catch TB. There is no window, just a
small opening with wire over it—not much ventilation,” Phiri, 17,
said.[257]
Isaac, 17, at Mukobeko, reported that there were “23 TB patients in my
living area. There are no vents, no air. I’m worried.”[258]
The officer in charge of Lusaka Central prison acknowledged that the lack of
ventilation was a severe problem.[259]

TB Testing

Since 1993, the World Health Organization (WHO) has
explicitly recognized the need for “vigorous efforts” to detect TB
cases through entry and regular screenings in prisons, and the need for
effective treatment programs and continuity of treatment upon transfer or
release.[260]
The Zambian prison system does have the capacity to diagnose some of the
prisoners it tests for TB (the diagnosis involves analysis of a sputum sample
under a microscope for TB bacilli). PRISCCA, ARASA, and Human Rights
Watch’s research found that, of prisoners we spoke with who had tested
for TB, 35 percent had been found positive. Nevertheless, our research
suggested that only a small segment of the Zambian prison population has
testing to diagnose active pulmonary TB, the form of TB that spreads quickly in
the overcrowded and confined spaces of Zambian prisons. Dr. Chileshe reported
that, in 2009, between 300 and 400 cases of TB were estimated in the prison
system based on reports from the clinics, but he was “sure there are
those who have TB who may not be [diagnosed].”[261]

Table 5: TB Testing

Lusaka Central

Mukobeko

Kamfinsa

Mumbwa

Mwembeshi

Choma

Overall (six prisons)

Prisoners Who Reported Having Been Tested for TB While
Incarcerated (%)

18

49

32

4

0

11

23

TB Testing for Prisoners

Our survey data yielded significant differences in TB
testing among prisoners we interviewed both between facilities and between
inmate groups within each prison. Testing was higher in larger, urban
facilities (Lusaka Central, Mukobeko, and Kamfinsa), and lower in smaller,
rural facilities (Mumbwa, Mwembeshi, and Choma). Among the smaller
facilities, TB testing among prisoners we interviewed ranged from a low of
zero percent at Mwembeshi to 11 percent at Choma; it ranged from 18 percent
at Lusaka Central to 49 percent at Mukobeko.

Within each facility, certain categories of inmates—women,
juveniles, remandees, and immigration detainees—were those least likely
to be tested. At all prisons where testing was conducted, except for Lusaka
Central, convicts were tested at significantly higher rates—overall
more than twice that of remandees, and more than four times that of
immigration detainees. Such a disparity is likely a result of a combination
of the security fears that keep remandees from accessing medical care
generally, discussed below; discrimination against immigration detainees in
accessing care; and the fact that immigration detainees have, on average,
spent less time in detention than convict and remandee detainees.

TB testing among juveniles was significantly lower than
that for adults at each prison where testing took place, and overall,
juveniles had a TB testing rate of only four percent compared to the adult
rate of 25 percent. Even at Mukobeko, where juveniles were been forced to
sleep with patients in the TB isolation cell, the juvenile testing rate was
only 17 percent compared with an adult rate of 53 percent. Women, as well,
had lower testing rates at each prison conducting testing, and overall only
11 percent of adult female prisoners we interviewed had been tested for TB,
compared with 28 percent of adult male prisoners. Such a disparity is
probably attributable to a combination of factors: women and juveniles had,
on average, been detained and incarcerated in their current facility for a
shorter time than their male counterparts; juveniles (but not women) reported
experiencing fewer health problems during incarceration and thus were
probably less likely to visit health facilities; and female inmates were less
educated than male inmates and perhaps less aware of and able to request
testing.

Table 6: TB Testing by
Prisoner Type

Prisoners Who Reported Having Been Tested for TB While Incarcerated

Significant delays exist between when inmates present with
symptoms of TB and when they are tested for the illness.[262] TB
should be suspected and tested for in individuals with unexplained weight loss,
loss of appetite, night sweats, fever, and fatigue. When the disease is in the
lungs symptoms may include coughing for three weeks or more.[263]
However, we spoke with two inmates at Lusaka Central on treatment for TB who
had waited three months for a trip to a clinic where sputum analysis could be
completed after reporting a cough to the cell captains or prison officers, and
two others who had waited over four weeks.[264] Indeed, medical
staff at some prisons informed us that TB is often the last cause of illness
tested for when an inmate presents with coughing, and treatment for upper
respiratory infections is first exhausted. The medical officer at Mukobeko
confirmed that TB testing takes place after the exhaustion of efforts to
address respiratory infection.[265]

Testing for preventative purposes, when an inmate has not
yet shown symptoms of infection, is almost entirely unknown: as Muntala, 39, an
immigration detainee at Lusaka Central, said, “they take you for tests
when you are coughing but by then it is too late.”[266]
Even inmates who face an elevated risk of TB infection due to their HIV status
are not routinely tested: One HIV-positive inmate told us that he had received
no TB test, though he had asked for one, because the Go Centre—the NGO
that conducts HIV testing at his farm prison, Mwembeshi—did not have the
capacity to test for TB. While they could give him a referral to the hospital,
“that would be impossible to get transport from here.”[267]
Across all six prisons, we found that 53 percent of HIV-positive prisoners had
been tested for TB, however, there is a striking difference between prisons.
While 94 percent—16 out of 17— of HIV-positive inmates at Mukobeko
had received a TB test, not one of the 10 HIV-positive inmates at Mwembeshi had
been tested for TB.

TB
Treatment

While an initial course of treatment is provided at all
prisons for inmates testing positive for TB, with medications usually
consistently available at Ministry of Health facilities when inmates were able
to access them, we found no testing and treatment for drug resistance. Drug
resistance testing and treatment in the Zambian general population is also
inconsistent and not widely available.[268] Yet drug-resistant
TB is a major public health threat—the WHO estimates that 300,000-600,000
new cases of multi-drug resistant TB (MDR-TB)[269]
emerge every year, with global prevalence as high as 1,000,000 cases[270]—which
emerged as a result of program failures, such as interruptions in drug supplies
and non-adherence to correct treatment and now may be transmitted from patient
to patient. The WHO has recognized that “[t]ransmission
in prisons is an important source of spread of drug-resistant TB in some
countries,”[271]
and that “badly managed tuberculosis treatment does not cure patients,
prolongs transmission of infection and promotes multidrug-resistant
tuberculosis.”[272]

At the prisons PRISCCA, ARASA, and Human
Rights Watch visited, there was an almost complete lack of knowledge of
issues around drug resistance—at the prisons and apparently at related
hospitals—even for inmates who had previously been treated for TB and
whose symptoms persisted or who appeared to be treatment failures. While the
WHO has noted that appropriate treatment for drug-resistant TB includes the use
of second-line drugs,[273]
with individual case management including a history of drug use in the country
and the individual,[274]
such procedures are not routinely followed. A nurse at the clinic serving
Lusaka Central prison informed us that “yes, we have encountered MDR-TB.
We recommence them on the same TB drugs as on first phase, but for longer. Then
if after eight months they are still not responding, we go to the relapse
drugs.”[275]
A significant problem is that healthcare staff report that

[We] do not know what drugs the prisoners have taken before
for TB. Often they tell us they were on TB medication before but they do not
recall anything about it. There are two prisoners now, they told us they were
on TB drugs before and we told them to come into the clinic, but we
haven’t seen them yet. We can’t just give them drugs until we see
what they were on.[276]

TB
Isolation

Zambian policy dictates that best practice for TB management
demands case detection, isolation, supervised treatment and follow-up support,
health education, and nutritional supplementation.[277]
If a prisoner is found to be suffering from an infectious or contagious disease,
under Zambian law, the officer in charge is required to take steps to place the
prisoner under treatment and prevent the disease from spreading to other
prisoners.[278]
The Ministry of Health recommends “isolation for all prisoners with
TB.”[279]
Yet Dr. Chileshe acknowledged that isolation is rare, and reported that only in
two or three prisons is there true isolation. In the rest of the prison system,
there is no isolation capability.[280]
“Our officers have tried their best to isolate patients, but they
can’t,” he said. “There is literally no space.”[281]
Two of the six prisons (Mumbwa and Mwembeshi) PRISCCA, ARASA, and Human Rights
Watch visited lack TB isolation facilities entirely, leading TB patients to
remain in the overcrowded and poorly ventilated general prison population cells
and risking spread of the disease.

In correctional settings, persons suspected of having
infectious TB should be placed immediately in an appropriate TB isolation room.[282]
TB isolation can be discontinued if a diagnosis of TB is excluded or when a
patient is no longer infectious.[283]
In Zambian prisons, by contrast, where isolation exists, only patients
diagnosed with TB are placed in the isolation cell; inmates with suspected TB
based on their symptoms remain in the general population until diagnosis,[284]
risking continued infection of the general population.

Even when patients are isolated (on the days of PRISCCA,
ARASA, and Human Rights Watch’s visits, Mukobeko Maximum Security,
Kamfinsa, Lusaka Central, and Choma claimed to isolate TB patients) the
conditions of TB isolation facilities are conducive to serious deterioration of
health. Indeed, the conditions of TB isolation cells—which at Lusaka
Central included nearly nonexistent ventilation and light and cramped, dirty
quarters for very ill patients, who sleep on foam pads on the floor—are,
in fact, life-threatening. 57 inmates on the day of our visit lived in an
isolation cell approximately four meters by eight meters. The medical officer
at Mukobeko informed PRISCCA, ARASA, and Human Rights Watch that TB isolation
facilities are improvised and that conditions are “pathetic”;[285]
“there were none designed, we are doing the best we can within available
resources,” another officer at Mukobeko explained.[286]
At Choma, former penal block cells are either used for TB isolation or for
grain storage.[287]

In fact, TB isolation facilities are likely a key site of TB
infection. Actively coughing residents in a dark, unventilated cell can quickly
spread TB or drug-resistant TB to uninfected cellmates. Augustine, 37, reported
that he was placed in isolation in 2007 but was found not to have TB and moved
out; he became ill subsequently and was diagnosed with TB. He believes that he
contracted it in isolation.[288]
Another inmate, 38, currently in the TB patients’ cell at Lusaka Central,
reported that some in the cell did not have TB and were being exposed to a high
risk of TB infection, as the cell has no ventilation and “the situation
is terrible.”[289]

An important reason why TB isolation cells may serve as a
source of infection is the fact that former TB patients are reluctant to leave
the cells, because even their squalor is preferable to the more crowded general
population cells. Kachinga, a prisoner at Lusaka Central, actually informed us
that he chose to remain in the TB isolation cell after completing his TB
treatment because the conditions there were slightly better than those in the
other cells:

I was tested for TB and put into the [isolation] cell. I
tested positive. I finished my course of treatment, tested again, and was
negative. I am still in the [TB isolation] cell. I would love to move out, to
give room to other patients coming in, but the other cells are congested.
It’s my choice to stay.[290]

Dr. Chileshe confirmed: “Where there are TB patients
there is more space, and inmates want to sleep there. You find pregnant women
in the cell with TB patients. You may say it’s not medically acceptable,
but what can you do?”[291]
The number of inmates remaining in isolation for periods beyond their time on
TB treatment is suggested by the fact that, at Lusaka Central, the prison
clinic had 34 patients recorded on TB treatment the day of our visit; the TB
isolation cell, by contrast, held 57 inmates.[292]

HIV/AIDS

The WHO has established standards on HIV prevention, care,
and treatment in prisons.[293]
The UN Office on Drugs and Crime (UNODC) has also established a framework for a
national response to HIV/AIDS prevention, care, treatment, and support in prison
settings.[294]While education, testing, and treatment for HIV have been
drastically scaled up in recent years in Zambia’s prisons—with the
help of NGO partners—significant gaps remain in the appropriate
implementation of these services, as well as in prevention practices, between
international standards and Zambia’s response to HIV/AIDS in prisons.

HIV
Testing

To the credit of Prisons Service officials and NGO partners,
recent years have seen the scaling up of HIV testing, albeit provided by an
NGO. The Go Centre/CHRESO Ministries provides HIV testing and treatment on
regular visits to three Lusaka area prisons (including Lusaka Central and
Mwembeshi), two prisons in Mukobeko (including Mukobeko Maximum Security
Prison), and a prison in Livingstone.[295] Access to testing
at several of the facilities was very good as a result of this program; at
others it was more limited, suggesting that even more remote facilities, which PRISCCA,
ARASA, and Human Rights Watch did not visit and which are not served by the Go
Centre, may have negligible access to testing and treatment. Voluntary
counseling and testing is also foreseen at the prison clinics at Lusaka,
Livingstone, and Mukobeko in the future; they are currently going through an
accreditation process with the Ministry of Health.[296]

On the day of researchers’ visits to each facility,
survey data across the six facilities confirmed that, while HIV testing is
significantly higher than TB testing, it is more consistently practiced at some
facilities than others. Larger facilities had higher HIV testing rates among prisoners
we interviewed, ranging from 54 percent at Lusaka Central to 86 percent at Mukobeko
Maximum Security; smaller facilities’ HIV testing rates ranged from 23 percent
at Mumbwa to 48 percent at Mwembeshi (which is visited by the Go Centre).

Table 7: HIV Testing

Lusaka Central

Mukobeko

Kamfinsa

Mumbwa

Mwembeshi

Choma

Overall (six prisons)

Prisoners Who
Reported Having Been Tested for HIV While Incarcerated (%)

54

86

72

23

48

33

57

Within facilities, as with TB testing, the prisoners we
interviewed reported that certain categories of inmates including women,
juveniles, remandees, and immigration detainees tended to be tested for HIV
less frequently than their adult, male, convict counterparts, likely for
similar reasons as for TB testing. Between all prisons, adult female testing
was 45 percent compared to 62 percent for adult males; 44 percent of juveniles
were tested compared with 59 percent of adults; and 46 percent and 21 percent
of remandees and immigration detainees, respectively, had been tested compared
with 65 percent of convicts.

Table 8: HIV Testing by
Prisoner Type

Prisoners Who Reported Having Been Tested for HIV While Incarcerated

Aside from inconsistent implementation, other challenges still
exist in the implementation of testing. The National HIV/AIDS/STI/TB Policy
requires that women considering having a child be encouraged to seek counseling
and testing, and ensures that every pregnant woman has access to HIV/STI
screening and treatment, but does not mandate mandatory prenatal testing.[297]
However, for female inmates, we heard troubling reports that HIV testing for
pregnant women may be mandatory.[298]
While one prison officer called HIV testing “voluntary”, additional
comments suggested that it may actually be mandatory: “For those who are
pregnant, they are tested for HIV....Whether you like it or not you are tested
to prevent transmission to the baby.”[299]

HIV peer educators had been trained through the NGOs
PRISCCA, In But Free, and Treatment Advocacy & Literacy Campaign (TALC)[300]
at several of the prisons PRISCCA, ARASA, and Human Rights Watch visited, and
throughout the prisons, detainees reported relatively low levels of
discrimination and stigma against HIV-positive inmates from either the officers
or other inmates. Researchers heard repeatedly that education campaigns have
proved successful: Orbed, 26, an HIV-negative inmate concluded that
“since the education campaign, there is no discrimination. The campaign
has really worked.”[301]

However, some inmate harassment and prison officer breach of
confidentiality lingers. Keith, 32, an HIV-positive inmate, told us: “I
have never faced any discrimination from the officers because of my HIV status.
From my fellow inmates I have faced a lot, though. It’s quite
difficult—when I stand in front of my fellow inmates to educate them,
some laugh at me.”[302]
Allan, age 34—an HIV-negative inmate—confirmed, “the
discrimination among inmates takes the form of mocking the person who is
positive. You have to hide the drugs if you want secrecy—it’s hard
to maintain....Officers will ask for a list of those wanting VCT and call the
names out loud. They will tell those who are negative to leave and those who
are positive to remain, so everyone knows what the results are.”[303]
Additionally, peer education has not been consistently implemented across
facilities within the prisons system, or sometimes within facilities
themselves. Paul, 33, an inmate in the “condemned section” at Mukobeko—where
inmates under sentence of death are held—reported that the condemned
don’t receive the HIV education offered to other prisoners: “We
feel like they think we will all die anyway so it doesn’t matter.”[304]

HIV
Treatment

Table 9: Number and Percent of Prisoners Who Reported Being
Started on HIV Treatment after Testing Positive

Access to ART has also improved among the prison population
in recent years. For inmates who have tested positive for HIV, ART is often
available to HIV-positive inmates at the prison referral hospital or through
the Go Centre/CHRESO, for those six prison facilities they serve. Of the
prisoners we interviewed who had tested positive for HIV, 60 percent overall
were started on treatment including ART, cotrimoxazole, or any other form of
treatment, 89 percent of them on ART. Prisoners at the larger prisons,
particularly Lusaka Central and Mukobeko Maximum Security (both served by the
Go Centre), were more likely to be started on treatment than their counterparts
at smaller, rural prisons.[305]

Furthermore, cotrimoxazole—recommended for all
individuals testing positive for HIV in order to treat opportunistic
infections—is almost entirely unavailable at all prisons, with only one prisoner
we interviewed being started on it after testing positive for HIV. In the
general population, by contrast, cotrimoxazole prophylaxis is generally
available at all Ministry of Health ART clinics, provided by the Ministry of
Health with the Center for Infectious Disease Research in Zambia (CIDRZ)
providing back-up for stock-outs.[306]

A high level of adherence is crucial for the success of ART.
According to the WHO, “adherence to ART is well recognized as an
essential component of individual and programmatic treatment success.”[307]
Research on drug adherence has shown that “higher levels of drug adherence
are associated with improved virological, immunological and clinical outcomes
and that adherence rates exceeding 95 percent are necessary in order to
maximize the benefits of ART.”[308]
Lack of adherence can lead to the development of drug resistance, illness, or
death. Zambian policy dictates that the Zambia Prisons Service—with
partner support—provide food supplements to HIV-positive prison officers
and inmates on ART.[309]The WHO has determined that “improved nutrition may
enhance ART acceptability, adherence, and effectiveness.”[310]
Food supplements are similarly important for individuals on TB treatment,
adherence to which is important both to cure them of TB and to avoid the
development of drug resistance.

Such supplements are not
currently provided, however. “They used to give extra food for taking
medications but no extra food now. It is hard to take these very strong drugs
without enough food” said Willard, 25, an HIV-positive inmate at Mukobeko.[311]
Even an inmate with a physician’s prescription for special food was
unable to receive it because “the prison can’t afford it.”[312]
Emmanuel, 35, an HIV-positive inmate at Mukobeko, had asked to be transferred
closer to his family so that they could supply him with better food, but was
refused: “I think all people on ART should be transferred if they
can’t feed us adequately,” he said.[313]

Table 10: Reasons for
Missing HIV Treatment

For prisoners who are on medication for HIV and TB, the
unavailability of food makes taking medication extremely difficult, even frequently
leading to missed doses. Among inmates on ART whom we interviewed, more than
half of them (55 percent) had missed doses, and lack of food was cited by more
than a third (38 percent) of those who had missed doses as the cause. Augustine,
37, an inmate on medication for TB, noted: “I am not getting enough food,
now that they are no longer giving food supplements for those on drugs. I feel
weak. I suspect that the drugs could be working but they are so strong I need
food for them to work.”[314]
Francis, 33, an HIV-positive inmate held at Mwembeshi farm prison, reported to
us that he takes his ART only once a day, in the evening, because he has no
breakfast in the morning to take the medication with: “I should take them
in the morning as well, but if I took them in the morning I could not work, as
I would be dizzy and weak.”[315]

Prison officers also lamented the health effects of lack of
nutritional supplements for HIV and TB patients.[316]
A nurse at the clinic serving Lusaka Central prison reported that the food is
“not nutritionally adequate” and the clinic does not provide any
extra food to people on HIV or TB drugs: “It is affecting whether they
get well,” she concluded.[317]
The HIV/AIDS coordinator at Lusaka Central has tried to obtain food supplements
for those who need them, in accordance with Zambian prison regulations, but the
authorities have been “sluggish” in their response. Without
sufficient nutrition, she noted, “someone can be on ART but still die, as
two have died of AIDS since I have been here [for nine months].”[318]
The officer in charge at Choma also confirmed that the prison’s lack of
capacity to provide supplementary food to both inmates and prison officers on
ART and TB treatment is a major challenge.[319]

HIV treatment to prisoners is highly dependent on the
intervention of the Go Centre at the facilities where that NGO operates; Go
Centre health professionals dispense the medication, which may be kept on the
inmates’ persons in between visits or delivered by a nurse. At Mukobeko
Maximum Security Prison, where the Go Centre conducts voluntary counseling and
testing (VCT) and provides drugs,[320]
the prison administration reported that 142 prison inmates were on ART, 15 of
whom were also on treatment for TB.[321]
At Lusaka Central, 113 prisoners were on ART, and 19 on both HIV and TB
medication[322]
through the Go Centre and Hospital.[323]
Waiting lists to access ART were reported both through government hospitals and
NGOs.[324]

HIV
Prevention

Zambian policy acknowledges that “[p]rison confinement
can increase vulnerability to HIV due to frequent unprotected sex in the form
of rape, non-availability and non-use of condoms, as well as high prevalence of
STIs.”[325]
Noting that “[p]revention is better than cure,” the Zambia Prisons
Service has set for itself the goal of ensuring “the implementation of a
comprehensive HIV prevention package.”[326] Yet we found that
the total unavailability of condoms and other essential means of prevention in
the context of a population with a very high HIV prevalence and widespread
sexual activity, consensual and non-consensual, creates a serious risk of HIV
transmission and seriously hinders HIV prevention activities.

International organizations—including the WHO, UNODC,
and the Joint United Nations Programme on HIV/AIDS (UNAIDS)—all recommend
that condoms be provided to prisoners.[327] In 2007, the WHO,
UNODC, and UNAIDS noted that studies have found condom provision in prisons to
be feasible, acceptable to prisoners, acceptable to prison staff, and did not
have negative consequences such as compromising prison safety or security.
Furthermore, “[f]ears about the provision of condoms leading to more
consensual and non-consensual sex were not realized.”[328]
Zambian prison policy has called for inmates to be provided with the means to
protect themselves from HIV.[329]
Zambian public health advocates have called for condoms to be introduced for
years.[330]
Dr. Chileshe has espoused the need for harm reduction in prisons because
“people are dying.”[331]

Yet condoms are, without exception, not provided to
prisoners and in fact are contraband. Indeed, instead of distributing condoms
to prisoners, the Zambia Prisons Service reportedly is considering installing closed
circuit television in some prisons at great expense, ostensibly as a means of
decreasing sexual activity.[332]
The unavailability of condoms is linked to the criminalization of same-sex
sexual activity between consenting adults (men and women) in the country as a
whole.[333]
Zambian law declares “carnal knowledge against the order of nature”
punishable by 15 years to life in prison[334] and “acts
of gross indecency” between same sex couples are punishable by seven to
14 years imprisonment.[335]
Though many reports of consensual same-sex sexual conduct in the general
population have been taken to the police, there have been no courtroom
prosecutions.[336]
The Zambia Prisons Service HIV and AIDS/STI/TB Strategic Plan 2007-2010 claims
that condom distribution to inmates is forbidden by law, and provides only for
condom distribution to members of staff, their family members, and inmates upon
discharge.[337]

PRISCCA, ARASA, and Human Rights Watch’s findings
confirmed a total lack of condoms in prisons; a strong homophobia and
resistance to condom distribution within the prisons among the prisoners
themselves; and a problematic association in HIV prevention messages between
same-sex sexual activity between men and HIV/AIDS, with no mention of harm
reduction or condom use. The issue of condom introduction currently evokes
strong responses from many inmates: Elijah, 34, an inmate at Mukobeko, said
“condoms can never be allowed by inmates because they are not useful. I
heard that the government wants to supply condoms in prison, but we wrote a
letter complaining to the commissioner. They would be a passport to sexual
activity if we had them. We will demonstrate if they bring condoms here.”[338]
Inmates’ responses to the idea of the introduction of condoms ranged from
describing condoms as “difficult to talk about”[339]to “not necessary”[340]to
“a disaster.”[341]

Cross-Cutting Failures in Delivery
of All Medical Services

Lack
of Prison-Based Services

Here, there is no medicine.

– Mwamba, 26, Mwembeshi Prison, October 6, 2009

The Zambia Prisons Service is in great need of medically
trained staff and equipment at the prison level, and medical facilities are
virtually non-existent at most prisons. Four of the prisons we visited had no
medical care available inside the prison, relying on the community clinic or hospital
to provide all medical care, in addition to the TB and HIV/AIDS services
discussed above. At Mumbwa, Japhet, 38, told us that, at the prison, “we
have no trained, qualified medical personnel. We only have a room, no medical
staff.”[342]
The officer in charge at Mumbwa agreed: “We don’t have medical
personnel to treat prisoners.”[343] A clinical
officer used to visit the prison, but had not done so for six months at the
time of our visit.[344]At
Mwembeshi, Mwamba, 26, reported “here, there is no medicine. The nurse
will give you a referral for the clinic, but they don’t take you.”[345]

Those prisons we visited which do have prison clinics often
only have paracetemol and lack basic equipment and infrastructure including
running water, disinfectant, and gloves. Despite reporting a wide range of
ailments, among the prisoners we interviewed, 19 percent of men and 36 percent
of women had only received painkillers and no other medicines. The chief
medical inspector at Kamfinsa reported that he is not satisfied with the care
provided to the inmates, as he needs more staff and better infrastructure and
equipment (including a blood pressure monitor, stethoscope, and forceps). He
had received no reply to his letter to the Ministry of Health requesting such
equipment.[346]
Prison clinics suffer from frequent shortages of medication. The chief medical
inspector at Kamfinsa confirmed that a “big problem is running out of
drugs at the end of each month. We get a three-week supply from the district,
so a one-week shortage happens regularly.”[347]

Lack of staff and drugs make medical care inconsistent.
According to Howard, 29, an inmate at Mukobeko, “sometimes they help you,
other times no one is there. Sometimes there is no medicine. The clinic has no
equipment.”[348]
Lawrence, 33, reported:

I take drugs for epilepsy. They should be taken daily. When
they are not available at the clinic, though, I don’t take. They are not
available once or twice in a month, and I miss at least one week a month. I
have seizures when I don’t have the drugs ... I have had three seizures
in the last year because I didn’t have the drugs. I usually have problems
because the medication is not available.[349]

Mumba, 44, confirmed: “Every time I try to go to the
clinic there is a shortage of drugs.”[350] “Medicine
is the problem; the clinic lacks medicine,” concluded an inmate at
Kamfinsa—“by the time you get to the hospital it is too late, you
have already been mistreated and the disease is advanced.”[351]
Clifford, 41, another inmate at Kamfinsa, described a similar
situation—that medical staff are serious but overworked and “they
have no equipment, not even a stethoscope.”[352]

Low levels of testing for TB, and prioritization of testing
for respiratory infections, may partially be attributed to the fact that
capacity for TB testing does not exist within the prison clinics or nearby
community clinics, whereas prison clinics (where they exist) may have
antibiotics. TB testing is not offered at Mukobeko,[353]
and Daniel, 39, a male convict at Mukobeko prison, said that in deciding whom
to take for medical treatment, prison officers “wait until you have no
strength left and then they will take you. Even with TB, lots of people are
coughing and spitting and they will let it go for months before they do an
x-ray....it takes a century for TB because they have to take you to the
hospital.”[354]
According to one officer at Mwembeshi:

Every a.m. I check my prisoners for signs and symptoms of
TB. Then I take them to our nurse, who takes them to the community clinic. But
they only do a sputum test; there are no further investigations. Our only
hope is UTH [University Teaching Hospital in Lusaka, 40 kilometers away].[355]

The unavailability of prison-based services is also a major
barrier to proper HIV treatment. CD4 count testing currently happens only
inconsistently, partly because CD4 testing machines are not available at any
prison. Prison officials at Mukobeko cited the lack of a CD4 count machine,
lack of fuel, and lack of transport, as a problem in providing proper HIV
treatment.[356]
J. Kababa, the officer in charge at Lusaka Central, informed PRISCCA, ARASA,
and Human Rights Watch that “There is no CD4 count equipment at the
clinic so I have to take prisoners all over the city. Officers don’t want
to take dangerous people out as they might escape and [the officers] will be
blamed.”[357]

Partly as a result of the lack of prison-based medical
personnel and infrastructure, there is a lack of individualized HIV treatment
or recognition of the possibility of drug resistance—inmates routinely
reported receiving the same dosage of ART as each of their fellows every three
months, without any individualized counseling, testing, or discussion, even
when their CD4 count showed no improvement over time. Emmanuel, 35, a prisoner
at Mukobeko, reported:

I started HIV meds two years ago, I am not doing well...I
have side effects of the medication including neuropathy, swelling, diarrhea.
It has been one year since I saw a specialist; they told me they have no
transport to take me. So they keep bringing me the same drugs every three
months.[358]

For many illnesses (aside from HIV and TB), church
representatives and well-wishers frequently fill the role of pharmacist,
obtaining medications for prisoners:

We visit the clinic by all means each time we are sick. We
are not denied access. But the kind of treatment we need is not found there. We
are referred, but we face a problem with that because the hospital is far and
we need fuel and transport. Normally, when they give us a prescription, our
relatives or the church people have to go and buy it.[359]

“When we are escorted [to the clinic], we are given
expensive prescriptions, but we can’t afford them,” an inmate at
Lusaka Central told us.[360]
Inmates reported that medicines are frequently only available through church
and well-wisher visitors: “Medication is provided by Father Bohan [an
Irish priest who visits the prison] on prescription from the prison clinic.
Deaths were so much, mostly amongst those on death row, before Father Bohan
came to our assistance.”[361]
Douglas, 40, an inmate at Mukobeko, concluded: “Without the priest, we
would hardly have any medicine.”[362]

Drug shortages are hardly surprising, given that the Prisons
Service provides minimal funding to fill the gaps when Ministry of Health-provided
supplies run short. As the officer in charge at Lusaka Central lamented,
“there is no prison budget for medical care. All of it is funded through
the Ministry of Health, so when funds run out, they say ‘use your own
prison budget,’—but there is none.”[363]
The officer in charge at Mumbwa agreed: “There is no budget for medical
care for inmates.”[364]

Barriers to Accessing Community-Based Medical Services

Access to community-based clinics and hospitals poses a
problem for many inmates. According to the nurse at the clinic serving Lusaka
Central confirmed, “There are problems with delays in prisoners getting
to the hospital. It can become a delay of weeks.”[365]

PRISCCA, ARASA, and Human Rights Watch interviewed inmates
who had waited long periods for referrals to outside medical services:
Clifford, 41, an inmate who had water on the lung outside of prison, had
received no treatment for the two years he had been in prison—he had
never been to the hospital, though he had asked many times.[366]
Inmates reported requesting treatment multiple times unsuccessfully: “I
had tried to seek medical treatment many times but have not received it. They
say sometimes they do not have an officer to escort us to the clinic. I have
requested to go six times and have been refused. I have many problems. When I
fell sick, I asked for attention, but was not able to go to the clinic.”[367]

According to prison officers, lack of personnel, transport,
and fuel to take inmates for care are all major barriers. The officer in charge
at Mumbwa said, “Sometimes we don’t have officers to take to the
clinic—so they cannot go”[368]; at Kamfinsa, the
officer in charge informed us that “staff shortage causes medical care
problems as I lack staff to take inmates to hospital.”[369]
The medical officer at Choma reported that delays in bringing patients to the
clinic as a result of shortage of manpower was the primary barrier to patients
accessing necessary testing and treatment.[370] Lack of transport
and fuel were named as major barriers in accessing medical care by prison
officers at Mukobeko,[371]
and the lack of transport to take inmates for medical care for specialized care
and referrals was also a challenge at Choma.[372] Even for
seriously ill prisoners, according to an officer at Mwembeshi, “we just
wait and find someone from the Prisons Service who is travelling to and from
Lusaka. It may take a week before a sick prisoner makes it to the
hospital.”[373]

Felix, 43, an HIV-positive remandee, reported:

I also have breathing problems....I was tested in prison
and was on TB treatment in 2007... in April 2009 I started developing the same
symptoms again. I went to the clinic and was referred to Kabwe General Hospital
for an x-ray, but the machine was not working. I have asked the officer to take
me again, but the officer said that I need another referral, and the clinic
hasn’t worked for the last two weeks because the clinical officer has
been away.[374]

We spoke with inmates currently on TB treatment who had
waited between two and three weeks and one month, respectively, to initiate
treatment after TB diagnosis.[375]
Concluded one, “I think that people in prison want to be tested for TB.
The delay to get tested is not at the hospital or the clinic. The delay is here
at the prison. For people to take us from here, it is long. Some people die
before they can be treated.”[376]
The officer in charge of Lusaka Central confirmed that the biggest problem he
faces with medical care is transport, and he is not satisfied with the medical
care for prisoners: “TB and HIV patients must go to the hospital, and the
numbers are so large there are delays.”[377]

Multiple inmates reported delays in proper HIV treatment as
a result of lack of prison-based services. Mwape, 47, who had tested positive
for TB and HIV, reported that he was on the wrong treatment for two years as
his CD4 count plummeted at Lusaka Central, where he was taken for treatment.
Now on second line treatment[378],
he reported feeling a bit better, but “there were delays in getting me to
the hospital—they cite security reasons and I have seen people die from
it.”[379]
Mutale, 40, at Mukobeko, informed us that “for opportunistic infections
it’s hard to get to the hospital. It can take two weeks
sometimes. The officers think we are just malingering. I often suffer
from symptoms like diarrhea and chest pains without treatment.[380]
An inmate at Kamfinsa Prison reported that he had been tested for HIV and found
positive, but had been waiting for a CD4 count test for five months.[381]
Frederick, 23, similarly informed PRISCCA, ARASA, and Human Rights Watch that
he had been waiting for a CD4 test after a referral to the community clinic, in
this case “because I look healthy and am new, they won’t let me go.”[382]
Another inmate, at Mukobeko told a similar story: “they are taking CD4 counts,
but rarely, like every six to seven months. For example myself, I have never
had my CD4 count since being here [since July 2008].”[383]

When care is delivered at outside clinics and hospitals, a
number of inmates also reported the stigma that they face from the general
population by virtue of their easy identifiability as prisoners.[384]
Chanda, 36, a convict at Mukobeko, expressed sadness: “They are tied to
shackles on both feet/legs and hands as they walk into the hospital outpatient
or admission wards, where they are also tied on chains to the bed and are not
allowed to go to the toilet but are provided with bowls where they should
either urinate or defecate in full view of all other patients and their bedside
caretakers or relatives. The majority of those who fall ill avoid being exposed
to such conditions and rather prefer to die within their prison cells.”[385]
Henry, 34, at Lusaka Central, reported discriminatory treatment:

At hospital the nurses discriminate against you because you
are a prisoner. I am shackled, and the nurses ignore us. I think it is because
we are inmates that they don’t take care of us. They have to send inmates
from the prison to clean up after the prisoners who are patients because the
nurses won’t do it. They discharge early, especially if the prisoner
can’t get to the bathroom himself. They get rid of them. Someone died a
week ago, he was very thin, very ill, and they took him to wash him but it was
too late, he died.[386]

A nurse at the University Teaching Hospital, the tertiary
referral hospital for the entire prison system, confirmed that when prisoners
are admitted, “they cuff them at the bedside” which presents a
problem as “sometimes there is no one to unlock them to take them to the
bathroom.”[387]

Security
Concerns

Sometimes it is difficult getting to the clinic,
sometimes you may not get to go. We ask the cell leader—the guards might
say no, though. For those who have big cases, they are afraid they may run
away. I have seen people turned away....They have no problem taking convicts,
but remandees have a problem because they are afraid we will escape.

– Peter, teenager, Choma Prison, October 8, 2009

Security concerns prevent many inmates from accessing
medical care in a timely manner. Mumba, 44, an inmate at Mukobeko, reported
that the practice of training prison officers in medical care led to a cadre of
medical professionals with misaligned priorities:

They used to bring in health personnel who were very good.
Now they have decided that they should train [security] officers to be health
personnel. But to add security when we are very sick? They may not refer
someone because of the fear of escape.[388]

Officers’ security fears in allowing inmates to go to
clinic facilities outside of prison grounds undoubtedly prevent prisoners from
accessing care, sometimes for extended periods. One “lifer” at Mukobeko
reported “I have bronchitis. I have had no treatment yet because of
security problems getting me to hospital. I’ve been waiting three years...they
won’t take you for treatment until it is too late.”[389]
Nickson, 36, an inmate at Mukobeko, reported:

I have been trying to push to ask for care, but it has not
been working....The prisoners are being oppressed here, we are suffering....We
are denied access to medical care. They do everything for the security of the
prisons...Last time I was sick was two weeks ago—I had malaria. I
suffered a lot, and everybody knew. I came to the clinic, and was given only
panadol [paracetemol]. I asked to go to the hospital, and was denied. They said
to me: “You remandees, you are problems—this prison is all about
security.”[390]

Chiluba, 32, a prisoner from Lusaka Central, who was injured
by a beating in police custody, was able to go to only the hospital upon direct
intervention by the prison’s officer in charge:

I was not examined on prison entry, and it took me one
month to go to the clinic. I was referred to UTH [University Teaching
Hospital]. It took so long because some prisoners would escape on way to
hospital. They had almost stopped taking people. I kept pressuring and upon the
officer in charge’s intervention was able to get two prison officers to
take me to clinic.[391]

Remandees, in particular, suffer from restricted access to
medical care. A contentious relationship between the Prisons Service and police
on the subject of remandee security and responsibility for remandees[392]
escorted out of the prison result in many prisoners across facilities reporting
that remandees are less frequently allowed to seek care than their convict
counterparts. Officially, Zambian law provides that every prisoner is in the
lawful custody of the officer in charge throughout the period of his
imprisonment,[393]
and according the deputy commissioner of prisons, “it is the
responsibility of the Prisons Service when remandees need to go out when it
comes to medical attention.”[394]
But the officer in charge at Mumbwa described the prison officers’
calculus:

With remandees, we fear to take them [to the hospital] because
we are afraid they will run away—the police will say we let them go
deliberately. The police are supposed to take them to the clinic, but
it’s rare, so normally they don’t go.[395]

Such uncertainty and fears over responsibility for runaway
remandees leads to denial of treatment. Semba, 34, a remandee at Mumbwa
reported: “I told the officer in charge about my [HIV] status—she
says the police will take you to get it because you are a remandee. I’m
feeling weak.”[396]
A remandee at Lusaka Central informed us:

I have ankle pain. While playing football, I injured myself
on the ankle. It gives me some pain even now. I have requested the officers to
take me for an x-ray but they refuse. They say I am not yet convicted, and they
fear I will run away.[397]

Johnston, 41, a remandee at Mumbwa, reported:

There is no clinic here. We complain but we are not
attended to....They don’t take remandees to the doctor. They take the
convicts but they say the remandees are going to run away. One or two who have
been very sick got taken to the doctor, but most of them just end up
complaining.[398]

Cell
Captains and Officers as Gatekeepers

I have seen people die in the night in the
cell—there is nothing we can do. We shout for someone, but the guards
will say, “He is just playing sick, he wants to escape. Let us wait two
or three days, and see how he will be.” And then he dies.

– Nickson, 36, Mukobeko Maximum Security Prison,
September 30, 2009

Prisoners depend upon the permission of cell captains and
officers to go outside the prison to obtain medical care. At farm prisons,
prisoners depend on the permission of cell captains and officers to miss work
in order to seek medical care. These cell captains and officers have no medical
training, but act as gatekeepers to medical treatment, occasionally with the
result that a prisoner becomes very ill or dies without being allowed to seek
medical care. Some inmates reported specific limits on the number of inmates
allowed to receive medical care each day, though PRISCCA, ARASA, and Human
Rights Watch were unable to verify what specific limits, if any, exist at each
prison aside from Mumbwa, which has a limit of 10 inmates per day. A female
inmate at Kamfinsa described the process of accessing care through the
officers: “When I feel pain, I give a request to go to the hospital. But
there is a limit of five a day to go to hospital so some get priority. Officers
choose who gets care on parade in the morning. If you are sick you raise your
hand, they choose five to go. There have been moments when more than five raise
their hands, but even then only five are designated for the clinic. I
don’t know how they choose.”[399] Angela, 23, reported:
“Sometimes you can go as long as a month waiting to go to the clinic...
it depends on the officers. Some officers are good, some are terrible.”[400]

Prison staff tend to discount prisoner complaints as
“malingering” or “tricks” in order to escape. Mwizya, 30,
an inmate at Mukobeko, told us:

Convicts and pretrial remandees looking health[y] are not
being attended to at the prison clinic or referred to Kabwe General Hospital
and are mostly accused of imposing a fake illness upon themselves so that they
can find a way to escape once admitted in the hospital ward. Prison officers
wait until the inmate’s health condition deteriorates before attending to
them.[401]

A remandee at Kamfinsa reported, “They work out their
personal vendettas against you by denying you access.”[402]

Other inmates—called cell captains or masters
depending on the context—also act as gatekeepers to accessing medical
care: “The masters decide who is sick; those who look fit—they are
told to go into their [work] groups.”[403] Martin, 39, an
asthmatic inmate at Mumbwa, told us, “The cell captains are preventing me
from getting treatment.”[404]

Refusals by officers and cell captains to allow inmates
access to treatment can lead to devastating consequences, as described by
Elijah, 34:

It is a struggle to get a referral; by the time you get it,
someone might die. We had three cases in my section who died in the cells before
going to the General Hospital or even the clinic. One had TB—but was not
tested for it—and the other two had malaria. If you want to go to the
clinic, the normal procedure is that the guards are supposed to pass through
and ask how we are feeling. But they don’t. So the inmates report
sickness to the person manning the gate. What happens depends on the
officer—sometimes you are not taken to the clinic, or the clinic officer
is not there. The three people who died were critically ill; the officers knew.
Three months ago, when one of them died, the officers were informed, but
didn’t take him to the clinic.[405]

PRISCCA, ARASA, and Human Rights Watch requested information
from the Zambia Prisons Service on the numbers and circumstances of deaths in
custody. At this writing, our request has not been answered, and we are thus
unable to assess claims of deaths due to officer negligence.

Immigration detainees, in particular, may face
discrimination from other inmates and officers in accessing care. As Jean
Marie, at Lusaka Central, told us, “I asked the officer to go to the
clinic but he said, you just need to wait for deportation. Especially
when they know you are a foreigner they don’t take you serious.”[406]

Prison officers confirmed that they—and in some cases
the captains—are gatekeepers for medical care, even expressing discomfort
with this position. The intelligence/offender management officer at Choma
prison reported that “we [assess inmates’ health] every morning, we
determine who goes to the clinic and who doesn’t, and screen them
thoroughly to prevent escapes.”[407] At Mumbwa, 10
inmates are taken to the clinic each day, regardless of whether more are on the
sick line. The officer on duty—who has no medical training—decides.[408]
The medical officer stationed at Mukobeko informed us that “there are
stages and monitoring by captains who take care of the sick.”[409]
The officer in charge at Lusaka Central expressed succinctly the problems
inherent in this system: “Leaving [when prisoners receive medical care]
up to me is not a good option, as I and my [staff] are not medical
people.”[410]

Range
of Services Delivered

Between the few prison clinics, and outside clinics and
hospitals, we found that inmates routinely do not receive certain types of
basic and essential medical care. Despite Zambian law providing for medical
examination of each prisoner upon entry,[411] our interviews
almost universally found, and the physician who heads the prison medical
directorate confirmed,[412]
that no medical screening or testing occurs for prisoners upon entry to a
facility. “We need monitoring,” said Dr. Chileshe. “It is a
mammoth task, the earlier we do the better. I want files for everyone, not just
the sick.”[413]

Shortages of all types of medicines (except ART and TB
medication) were an element of our findings at each facility we visited, both
at the prison clinics and reportedly at outside Ministry of Health hospitals
and clinics (therefore also impacting the general population). Lawrence, 33, reported
that at the hospital, “most of the good medicines are not
available.”[414]

Mental health services are grossly insufficient for
prisoners, though they are also entirely insufficient for the general
population.[415]
Zambian law requires that social workers, psychologists and—when
necessary—psychiatrists should be seen as “crucial players in any
multidisciplinary response to problems such as HIV and AIDS,”[416]
and international standards provide that “the medical services of the
institution shall seek to detect and shall treat any physical or mental
illnesses or defects which may hamper a prisoner's rehabilitation.”[417]
Current mental health facilities for prisoners are essentially non-existent.
Prisoners with “complicated” mental illness are sent to the prison
wing of Chainama Hospital, a Ministry of Health facility that in February 2010
housed 19 inmates found either not competent to stand trial or criminally
insane.[418]
However, for those mentally ill inmates in the general prison population, the
Prisons Service does not employ any person responsible for mental illness and
does not have any psychiatrist or other mental health professional on staff.
Dr. Chileshe reported that patients with mental illness may be held at Lusaka
Central, and in that case, “as is possible,” they receive
medication, though there were no specific medications for mental illness in the
medication cabinet of the prison clinic at the time of our visit.[419]

Multiple inmates reported symptoms suggesting mental health
issues. As James, 36, a condemned inmate said, “inmates start
hallucinating, planning to get out, because of an inability to have appeals,
proper food, and progress in our education. As a result you see mental deterioration
in the condemned. I can say this is happening to 101 percent of us.”[420]
The mentally ill further suffer from the loss of the little medication they are
prescribed: “benzodiazepines are stolen from the mentally ill. The
government doesn’t care about the mentally ill.”[421]
Artane (Trihexyphenidyl), prescribed to the mentally ill, is also frequently
stolen or sold for food and other basic necessities and diverted within the
prison.[422]

Women’s
Health

Women face a distinct set of healthcare needs in detention.[423]
Yet women are a minority and often receive little attention.[424]
In addition to experiencing the problems accessing care described above, our
findings suggested that incarcerated women in Zambia also face distinctive
challenges.

International standards dictate that for women in detention,
there shall be “special accommodation for all necessary pre-natal and
post-natal care and treatment.”[425] Prenatal care is
widely available in the general population.[426]
However, the incarcerated pregnant women PRISCCA, ARASA, and Human Rights Watch
interviewed described inadequate, and in some cases non-existent, pre-natal
care. Helen, 27, who reported she was six months pregnant, said:

I have not been to the clinic yet, no antenatal care. I
went to the clinic once but was told the nurses were not working. Since then I
have not asked. I do not feel well, lots of ups and downs.[427]

Pregnant women face the same challenges in accessing care as
other inmates: “It’s hard...they only count few of us for
treatment, then tell the rest of us to wait for tomorrow and restrict us from
going. I had no initial exam when I came to the facility, even though I am pregnant.
No special treatment is given for pregnant women, I take whatever I can.”[428]

In other cases, pre-natal care existed but was inadequate.
The WHO protocol for Prevention of Mother to Child Transmission (PMTCT) of HIV
notes that even “[a]ll HIV-infected pregnant women who are not in need of
ART for their own health require an effective ARV prophylaxis strategy to
prevent HIV transmission to the infant. ARV prophylaxis should be started from
as early as 14 weeks gestation.”[429] The chief medical
inspector at Kamfinsa prison claims that the WHO PMTCT protocols are
used—though they change and additional training is not provided.[430]
Yet, Tasila, 24, an inmate at Kamfinsa, who was eight months pregnant, reported
treatment directly in violation of WHO guidance:

I already knew when I came in that I was pregnant. I have
accessed care three times since I have been in here. The first day that I went,
they felt my tummy and told me that the fetus was too small. The second time,
they took a blood sample and told me that the baby was growing. The third time,
I had VCT—they tested my blood again and told me I was HIV-positive. They
told me my CD4 court was too high for ART. I wasn’t given any HIV drugs
to prevent transmission, only folic acid and vitamins.[431]

Dr. Chileshe noted that there is no PMTCT program in the
prison medical directorate,[432]
though PMTCT has been scaled up in recent years in the general population:
Between 2004 and 2007, the estimated percentage of women living with HIV who
received ART for preventing mother-to-child transmission increased from 18 to
47 percent.[433]

Pregnant women also face stigma when accessing maternity
care in public hospitals, accompanied by prison officers.[434]

Women also had not received any gynecological, cervical, or
breast cancer screening, though the availability of such services is also
limited in the general population.[435]

Child
Health

Despite provisions in the Convention on the Rights of the
Child noted above guaranteeing children’s right to health, PRISCCA,
ARASA, and Human Rights Watch also heard reports from mothers held in prison
with their children under age four that those children do not consistently receive
adequate health care, and face similar medical care challenges as incarcerated
adults. We heard a report at Lusaka Central Prison that a baby had died
recently of diarrhea, and was sick for three days before going to the clinic.[436]
Inonge, 42, informed PRISCCA, ARASA, and Human Rights Watch that “my
child had a high temperature and cough. She was taken to the [community] clinic
by prison officers but there was no medicine.” Instead, a donation from a
religious organization allowed the mother to purchase medicine for her
daughter. “Sometimes there are no medicines for my baby,” Inonge
concluded.[437]

Children detained as juvenile inmates frequently are
confronted by restrictions on their ability to access medical care similar to
those faced by adult prisoners, despite international law protections. Isaac,
17, was wheezing when PRISCCA, ARASA, and Human Rights Watch spoke with him. He
had asked at the clinic for help with his breathing troubles, and they had said
that they would take him to the hospital, but seven months had gone by and he
had still not been taken to the hospital.[438]

Continuity
of Care

What medical care prisoners do receive suffers from
interruptions upon transfer between facilities and upon release from prison.
Mulenga, an inmate at Mukobeko, reported,

I was being seen by a specialist in Lusaka [prior to
arrest] but here they won’t allow me to keep seeing that doctor. I get
some care at Kabwe General but there is a conflict in treatment. My medical
records are still in Lusaka, and I am trying to convince my relatives to
retrieve them and bring them here, because Kabwe General said that it is too
tedious to request them.[439]

In Zambia, inmates face interruptions in medical treatment
upon release from prison, when no provision is made for continuity of care. The
Zambia Prisons Service does not have a policy on coordinating medical care on
entry to, between, or upon exit from custodial settings. Inmate files are lost,
inmates have difficulty knowing where to go to receive care, and inmates
returning to rural areas may find themselves entirely unable to continue
treatment upon release.[440]
The Prison Fellowship of Zambia operates one halfway house in Lusaka, which can
accommodate up to 20 inmates; but they are the only prison reintegration
program operating in Zambia. “The prisons don’t have reentry
programs,” they reported.[441]
One former inmate reported that, while having chest problems upon discharge, he
received no medical record: “I just came out without a medical record.
Who is going to give me a medical record?”[442]
The prison clinic at Lusaka Central confirmed that, while they actually keep
records for all patients seen, there is no mechanism for patients to obtain
their medical record information upon release from prison.[443]

Non-scheduled interruptions in HIV treatment can result in
illness, the development or drug resistance, or death. Yet interruptions in HIV
treatment result from transfers, discharge, and in the entry process itself, at
the police station. Pre-trial detainees in police custody face particular
risks. Aaron, 26, informed us that he spent 42 days at the police station:
“I was on ART at the time but they would not let me bring my medication
from home. Between the delay at the police station and upon entering prison, I
missed three months of HIV medication.”[444]
Misheck, 32, reported, “I did miss doses [of ART] for a while right after
I was arrested when I was in the police station for four months. They
don’t give you any medicine there, or food. My family brought my drugs
but the police hid them.”[445]
Police Service officials acknowledge that interruptions in medical treatment
may take place when individuals are taken into custody and then are taken to
prison and admitted a need for a single medical directorate to coordinate care
for inmates in police and prison custody. Medical records don’t transfer
with an inmate, and medical services for the Police and Prisons Services are
coordinated separately.[446]

Record-Keeping
Problems

Accurate statistics on disease and death within prisons are
important both for public health purposes—to address current morbidity
and mortality, and plan for prevention and treatment—as well as to establish
grounds for recourse for prisoners whose illness or death may be due to
government action or inaction. However, it is currently difficult to establish
the actual number of people who become ill or die in Zambian custody. Dr.
Chileshe specifically warned PRISCCA, ARASA, and Human Rights Watch not to
trust any of the numbers currently reported by the Prisons Service, as
statistics are not compiled reliably either by the Prisons Service or the
different clinics and hospitals prisoners attend.[447]

Inmate reports of illness and death were widely divergent
from officer reports. At Mukobeko, one inmate told us, “people infected
with TB are held together with those with HIV, who are not cared for or given
supplemental foods. I would say that four to five people a month die. In April
it was 15 in one month.[448]
The Legal Resources Foundation claimed: “People die in the night and they
bring out the corpses. Many die—three a week at Lusaka Central.”[449]
At Lusaka Central, however, the officer in charge informed us that there were
20 deaths in all of 2008—14 male convicts and six male remandees, of “TB,
HIV and malaria”—in 2009, one death through October 2009.[450]
Death reporting is likely to be inaccurate, as inmate deaths are not officially
investigated if they take place in the hospital—only if they actually
take place in the cells. This contravenes Zambian law that provides for the
prison medical officer to record the cause of all deaths and past illness[451]
and international standards call for an inquiry into each prisoner death.[452]

Prison officers reported HIV and TB to be the primary causes
of inmate deaths, but such claims are impossible to verify as the vast majority
of these deaths occurred in the hospital and so were not investigated.[453]

Medical
Care Challenges at Farm Prisons

At the prison, we work all day, work all day—no
good. I am feeling a pain when I’m talking. I can die. We are working.
People are sick here in prison....We are not going to hospital here, please
help me to go to hospital. I have told the officers. I want to die. I have no
help here now. I don’t know if I can die. I have told them I am
sick—I was told to wait.

– Gabriel, 45, Mumbwa Prison, October 5, 2009

Inmates at farm prisons appeared to be particularly
restricted in their ability to access medical care, as their attempts to do so
were frequently rejected as a ploy to avoid work. Inmates at Mwembeshi reported
that they were sometimes not allowed to go to the clinic or hospital when sick,
and instead were made to work: “It is not possible here to go to the
doctor. At the moment we wake up, we go to the field, then we go to a different
field. Even if you complain it is not ok—the officers tell you that you
still have to go, and instruct the masters to say no.”[454]
Only as a last resort, when inmates are too weak to work, are they taken to the
hospital for treatment.[455]
The ill are routinely taken to the fields to do hard labor: “At this
prison, you tell the cell captain you are sick, they tell the guards you are
not. Some of the prison officers are not very good. The one on duty
doesn’t listen to complaints, doesn’t write down names. Those who
are not very ill are taken to the hospital. I don’t know why—but
the very ill are taken to the fields.”[456]

Distant from health facilities—at Mwembeshi, the
nearest hospital and ambulance are 40 kilometers away in Lusaka, and even the
local community clinic is four kilometers from the prison[457]—inmates
are dependent on visiting medical professionals for health care. Rabun, 28, an
HIV-positive detainee at Mwembeshi who reported sores on his genitals,
described some of the complications attendant on relying on visits from
visiting medical staff from University Teaching Hospital (UTH) or the Go
Centre:

UTH visitors have monitored me, but I am on no HIV
treatment and no treatment for the sores on my genitals. It is difficult
because of the lack of medical facilities here—we depend on doctors from
UTH. Sometimes when I feel sick the officers don’t take us to the
hospital. They rarely take us for medical attention. Sometimes they allow us to
remain at the prison, other times we go to work. I have had sores on my
genitals for two weeks. I asked to go to the clinic, and they promised they
will take me tomorrow, but when the day comes they have changed their shifts
and a different officer comes in. They keep on promising, but it does not
happen.[458]

Inmates reported that they sometimes had to bribe the inmate
“chairman” designated to make the list for the Go Centre in order
to obtain a place on the list.[459]

Corporal Punishment and Ill-Treatment

Solitary confinement, naked, in water with limited food;
corporal punishment by prison officers; beatings by cell captain inmates to
whom disciplinary authority is ceded; and beatings in the fields, constant
work, and denials of water for inmates sentenced to hard labor all amount to
cruel, inhuman or degrading treatment. Prisoner treatment and
discipline—at the hands of both prison officers and the inmates to whom
disciplinary power is delegated—often violate international and regional law
and standards. Widespread physical abuse, humiliation and ill-treatment also
have serious implications for inmates’ mental and physical health.

International law and prison standards, and the Zambian
Constitution, prohibit the infliction of (including acquiescence to) torture or
cruel, inhuman or degrading treatment or punishment against persons in
detention, including corporal punishment.[460] The UN Human
Rights Committee has admonished Zambia for reports of torture and ill-treatment
of persons deprived of their liberty[461]
and for failing to supply information on the system for prosecuting and
punishing acts of violence against prisoners.[462]
Additionally, international standards forbid prisoners from being employed in
any disciplinary capacity, or being punished by placement in a dark cell.[463]
In response to a complaint from a disabled child detained in a solitary cell
without facilities, no natural light, without a blanket or clothing, and
subjected to physical abuse, the UN Human Rights Committee noted that confinement
in an isolated cell “without any possibility of communication, combined
with his exposure to artificial light for prolonged periods and the removal of
his clothes and blanket” constituted a violation of the obligation to
treat detainees with dignity.[464]
Zambian law clearly lays out disciplinary infractions of varying severity and
makes provision for punishment,[465]
and some inmate reports suggest that corporal punishment from officers has
decreased in recent years following a change to the law.[466]
Yet officers and inmates still routinely inflict corporal and other
inappropriate punishments, contrary to Zambian law and Zambia’s
international human rights law obligations.

In cases of abuse, prisoners should be able to access a
remedy. International standards provide that detainees should have access to a
confidential complaint mechanism.[467]
Yet Zambian prisoners do not consistently have access to such a complaint
mechanism.

The Penal Block

Mostly, people come out sick. No one has come out in
good health—they change completely in there. They don’t always get
taken to the clinic, though, unless the inmates put pressure on [the officers].
We say, “this person will die, as you killed the others.”

– Elijah, 34, Mukobeko Maximum Security Prison,
September 30, 2009

Except Mwembeshi, each of the facilities we visited had some
form of penal block isolation cell where prisoners could be taken for
punishment in response to violations of prison rules ranging from engaging in
sexual activity, to using alcohol or drugs, to fighting, to disrespecting
officers.[468]
We were allowed to view the penal block at only one of the
facilities—Mumbwa—and observed it to be a dark, two meter by two
meter cell, without ventilation. The room was empty, with a bare, hard floor,
but the graffiti on the walls told the tale of the misery that had been
experienced within the cramped walls: “hard, no, no,” “fools
seek to blame,” “sucuide,” (sic) and “hard men no
no,” had been painstakingly etched into them.[469]

Zambian law provides for confinement in a separate cell as
punishment for certain prison offenses, with a “penal” or reduced
diet, for periods as long as 25 days.[470] Prior to such
confinement or reduction in diet, a prisoner must be examined by a medical
officer and periodic checks of the prisoner’s condition are required by
Zambian law and by international standards in cases of confinement or reduction
of diet.[471]

The descriptions from inmates of punishment inflicted in the
penal block were consistent across facilities.[472]
Prisoners are stripped naked and put in a small, usually windowless cell (one
to two meters by one to two meters), with water poured onto the floor to reach
ankle or mid-calf height. There is no toilet in the cell, so that inmates are
forced to stand or sit in water containing their own excrement. Prisoners sleep
in the fetid water on the floor of the cell. Prisoners are held in this manner sometimes
for days on end[473],
either with no food at all for shorter (daytime) stays or with “penal
diet” (food rations only every other day) for longer stays.[474]
However, as Henry, 34, noted, even eating this minimal food puts inmates in a
terrible bind: “You refuse food because there is no toilet.”[475]
Bernard, 40, described the ordeal of the penal block in detail:

I went to the penal block one time, but I only stayed for
one night because I was coughing up blood and they were afraid I would die. But
others stay for two weeks, 21 days, or 30 days. It’s dirty there, not fit
for humans. That’s where they used to keep people to be hung when there
were still executions. It’s hell all on its own. They remove your
clothes, put you in one of the rooms, and pour two buckets of water in there
with you. Then you get a penal diet—it’s the same food but just
less. One of our friends was taken there and beaten to death.[476]

In the winter months, especially, naked confinement in fetid
water is extremely difficult for inmates to bear and we heard reports that
inmates frequently require medical attention and even die after release from
the penal block.[477]
“Usually when one comes out of there one is weak and sick,”
Lawrence, 33, at Mukobeko, observed.[478] Mumba, 44, at Mukobeko,
reported that “many have come out sick—you don’t always get
ART in there.”[479]

There is little doubt that the use of these cells per se to
inflict punishment constitutes prohibited inhuman and degrading treatment.
Extended use of these cells when combined with other punishments, such as being
stripped naked, food restrictions, denial of access to the toilet, and being
made to stand ankle-deep in water, constitutes a form of torture.

Some inmates described officers who relish the pain of the
inmates: “They pour water in there and put you in there naked. The water
stays on the floor, and you can’t sleep. The guards enjoy it if you
commit an offense when it is coldest.”[480] Indeed, Winston, 35,
reported that officers sometimes use penal block punishment to settle personal
vendettas:

If you make a complaint about an officer, you have started
a war that will never end. There is systematic harassment; I know because
I have been in the forefront of making such complaints. The commanding officer
will come and say, “Those of you who want to act like you are a student
union at university, you will stay here. If you want to get out you will
shut up. Stop complaining, you have no rights; you are just criminals.”
Officers use other inmates to make complaints about you and you end up on the
penal block. It happens a lot.[481]

Several officers confirmed inmate descriptions of treatment
in the penal block. The deputy officer in charge at Mukobeko said: “We
remove clothes to prevent the risk of committing suicide. They are with nothing—no
bedding, no clothes. The duty officer can pour water in.... This can be with or
without penal diet—we remove portions from every meal. We have two cases
or so a week.”[482]
At Mumbwa, the officer in charge similarly described the punishment in penal block.[483]
Some officers expressed concern about the use of the penal block: The officer
in charge at Kamfinsa said that the penal block is available but “we’re
discouraged from it...because of human rights awareness we don’t do
it,” as the Prisons Act requires frequent checks on those in penal block
and he doesn’t have the time; furthermore, the penal diet cannot be used
because it is inadequate.[484]

Some inmates reported that prisoners are beaten prior to or
during confinement in the penal block.[485] “There is
also torture there,” reported Samuel, 50, at Kamfinsa. “People are
beaten with sticks. The convicts are whipped when they commit an
offense.”[486]
Mutale, 40, an inmate at Mukobeko reported that his friend was beaten to death
in the Mukobeko penal block in 2006, and while officers investigated after the
inmates protested, there was no arrest[487]; another inmate
reported that a fellow prisoner died from beatings at the Mukobeko penal block
in 2007.[488]
The penal block, Patrick, 48—an inmate at Kamfinsa—concluded, is
“not a safe place. They do things there the old Zambian prison
way.”[489]

While typically, children did not appear to be subjected to
penal block punishment, Oscar, a teenager, had been held in the penal block at
Lusaka Central three years previously, and described the terror he felt:

I have had the experience of being taken to the penal block.
There is a small room, where three people can sit. They pour water. You are
isolated, in the room alone with the water. They took me there when I came in
as a young person [as punishment for theft]. I was kept in there for four days
and nights in the cell. The water was above my ankles. There was no light, no
windows. There was no beating—the isolation, the water are the
punishment. It being the first time, I was really afraid. It was pitch black. I
didn’t know what was coming next. I felt very afraid and insecure.[490]

Additional Officer Punishments

The Zambia Prisons Service has clearly made a significant
effort to improve disciplinary practices in recent years. The legal abolition
of corporal punishment by officers speaks to a commendable desire for and
effort toward change in some quarters, and some inmates informed us that
officer-inflicted beatings had decreased.[491] One of the most
common forms of punishment by officers, reported by numerous prisoners across
all prisons, is the loss of early release (“adding days” to the
sentence)[492]—a
punishment that is acceptable under international standards. Forms of work are
also frequently used by officers as punishment.[493]
It must be noted, however, that seemingly acceptable forms of punishment may at
times be inflicted in discriminatory or otherwise unacceptable manners.[494]
One immigration detainee at Lusaka Central reported that when any one of the immigration
detainees violates a rule, all of the immigration detainees are made to clean
the toilets.[495]

Significant challenges remain in eliminating inappropriate
officer punishments. Corporal punishment of prisoners is contrary to Zambian
law, and prison officers categorically denied that
officers inflict corporal punishment. The officer in charge at Mukobeko reported
that punishment is never physical,[496]
and prison officers from Kamfinsa informed us that there is no beating.[497]
At Lusaka Central Prison, the female deputy officer in charge claimed:
“This has changed according to the Prisons Act. There is no violence
since I came, no violence here. We keep according to the law. There is no
physical punishment. We are just friends.”[498]

International monitors have expressed concern that practical
implementation of the abolition on corporal punishment may not have taken
place,[499]
and our interviews with inmates confirmed that corporal punishment by some officers
endures, despite a general trend away from such punishment. An inmate at Mukobeko
told us that he was badly beaten by a senior prison officer after he asked for
a parcel sent to him by an overseas penpal.[500] Ngwila, 67, reported
that just the previous week he had been beaten, and that the officers sometimes
beat the inmates for no reason.[501]
Clifford, 41, an inmate at Kamfinsa, said “someone just got taken to the
penal block today. This is where the worst abuses happen—beatings by
junior officers. They operate without supervision from the officer in charge.”[502]
As noted above, such beatings sometimes precede or take place during penal block
confinement. One inmate told us:

When a person becomes unruly, the officers use excessive
power, manhandle him, and beat him up. I witnessed one such incident at Lusaka
Central prison. The prisoner misbehaved and there was a mini-riot. The officers
had to come in and they beat him up and confined him to the penal block.[503]

Female inmates at Kamfinsa prison reported that inmates are
slapped on the back by officers as punishment[504] and
also receive strokes with a stick.[505]
Inmates at Mwembeshi reported slapping and beating by the officers when inmates
resist work.[506]
David, a teenager, described officer beatings in more detail:

As for physical abuse, some of the officers are harsh and
can slap prisoners or call us names. Yes, I have seen injuries after. Some of
the inmates, when they are given work, they resist and say they are tired. They
attract physical abuse, slapping. They may bleed from the mouth after, or
complain of internal pain.[507]

Erick, a teenager, reported that officers beat inmates as
punishment without the knowledge of the officer in charge:

When the inmates demand to go to hospital they are
prevented from going so that the officer in charge doesn’t know an
officer has injured an inmate. The officers tell the lie that the duty officer
is not available to keep us from the clinic, saying that the officer in charge
has traveled. The cane is two inches thick, two feet long. I have been caned
two times personally. Once, I felt sick because of malaria and I was not able
to eat. They said it constituted a crime, that if I don’t want to eat, it
constituted a crime. They said if I don’t want to eat, I should give to
share with a friend. I was given 10 strokes. The second time, I had visitors
from the church who wanted to help me with my case. I was ordered to clean the
toilets, but my absence led to be being given 25 strokes. I asked to go to the
clinic, but was denied. I was swollen.[508]

Additional reports of abuse at the direction of officers
include forms of sexual humiliation, particularly of female inmates. On the
women’s side of Kamfinsa Prison, for example, female prisoners reported
being stripped naked, smeared with mud, and placed in the hot sun of the prison
central courtyard to be viewed by all female prisoners for an entire day as
punishment at the explicit direction of the officers.[509] One
female inmate described this punishment:

If an order is broken, the inmate is stripped naked, mud is
applied by other inmates at the direction of the officer, and the inmate is
told to sit in the sun until lockup. Mainly this would happen if between
inmates we fight or pick a quarrel—the officers come to judge who is
wrong and then to punish. Some have fallen sick after that treatment—I
have seen it happen three times.

This punishment is aimed at humiliating or insulting our
personality. How can they make me strip naked before younger women who could be
my daughter, without taking to consideration how I would feel as a woman, as a
mother?[510]

Further forms of sexual humiliation and verbal abuse exist,
particularly for female inmates. For example, one inmate reported that as
punishment, the officers may put the inmate into the center of a circle of the
other prisoners at bath time, where each “showers insults at her, calling
her the names of private parts.”[511] Agnes, 25, at
Kamfinsa told us “truthfully, each officer has her own problems. Some are
harsh, some don’t accommodate us. To tell the truth, we were told to say
that there are no problems, but each has their own problems....They degrade us,
shout, call us names, make reference to the fact that we are criminals.”[512]

A child detained at Choma reported that another child was
tied with a rope and taken out into the sun for approximately two hours for
screaming at an officer.[513]
Adults at Choma also reported a practice whereby a prisoner would be drenched
with water and made to roll on the ground.[514]

Strip searching by officers, while not inflicted as
punishment, also greatly disturbs inmates. Inmates reported that they were
strip searched, both when returning from court, and at regular intervals in the
cells themselves. Multiple inmates reported the shame involved. “I feel
grieved about it,” a female inmate at Kamfinsa Prison reported, “I
even pray to God that I can just die. The pain and shame is too tough to
bear.”[515]
In one instance, PRISCCA, ARASA, and Human Rights Watch received a report from
a prisoner at Lusaka Central that a body cavity search for all inmates was
carried out with a single pair of gloves,[516] an
unsanitary practice compromising the health of inmates. Officers, however,
denied such treatment: “When we suspect a prohibited article, we carry
out a search. We look under beds, in hidden places. We don’t undress
physically, but we do rub down. We never look inside bodily cavities, it is
against human rights.”[517]

Cell Captain
“Justice”

The captains are police in the cells—what they do
in the cells, I don’t know. Sometimes they do punish their friends in
their cells—I don’t know how they do it. They have their own court,
without the officers involved.

– Officer in charge, Mumbwa Prison, October 5, 2009

Despite the instances of officer punishment described above,
the majority of punishments are in fact meted out by “cell captain”
inmates, to whom officers have delegated disciplinary authority, to some extent
as a result of overcrowding and unwieldy inmate-to-staff ratios. By Zambian law
and international standards, “[n]o prisoner shall be employed in any
disciplinary capacity.”[518]
The government maintains responsibility for abuses conducted by inmates with
government acquiescence. In the cell, however, captains function as the
ultimate authority: “Captains are the rule of law in the cell. They tell
you when to stand, when to talk. They prohibit fighting or verbal abuse. They
set the urination procedure, and make sure people take baths.”[519]

The prisons are currently understaffed. While all officers
in charge reported that an ideal staff-to-inmate ratio would be one to five,
this ratio was not achieved at any of the prisons we visited.[520]
“We have 900 more inmates than we are supposed to have. The prison is six
times more crowded than its original design,” said the officer in charge
at Lusaka Central. Inmate cell leaders “protect” other inmates and
“ensure discipline” by “serving as the officers’ eyes
and ears.” He admits that “this is not a preferred correctional
method,” but due to overcrowding and “an ever-rising number of
inmates,”[521]
he is left with little choice. “I have a staff shortage,” the
officer in charge at Mumbwa informed us—“it leads to
problems.”[522]
Throughout the prison system as a whole, prison staffing has remained at 1,800
since 1954, and has not kept pace with corresponding increases in the prison
population.[523]

Low staffing numbers have effectively led to the adoption of
a parallel system of justice dispensed by inmates. A progressive
“stage” system of inmate elevation is established by law, and
allows prisoners to receive special privileges based on good behavior or
leadership.[524]
Cell captains within each cell are drawn from among the “blueband”
category; “masters” in the fields are also bluebands.[525]

Officers in charge differed on the extent to which cell
captains are accorded the privilege of inmate discipline. The officer in charge
at Kamfinsa informed us that, while there are “not enough staff to
supervise the inmates,” “inmates are not permitted to punish other
inmates.”[526]
The officer in charge at Choma agreed that “the cell captains have power
to control fellow inmates by reporting offences such as cigarette smoking in
the cells, which is forbidden. The cell captains do not have powers to
discipline or punish other inmates.”[527] However, the
officer in charge at Mukobeko admitted that cell captains could discipline
other inmates for minor offences by instructing the offenders to clean toilets
or prison surroundings.[528]
The officer in charge at Mumbwa was most direct: “The captains are police
in the cells—what they do in the cells, I don’t know. Sometimes
they do punish their friends in their cells—I don’t know how they
do it. They have their own court, without the officers involved.”[529]

Untrained, poorly supervised and invested with immense
authority, cell captains wield their power arbitrarily over other inmates,
resulting in prisoner exploitation and widespread abuse. As Keith, 32, described,
“the cell captain maintains discipline on the inside....There is a
division of labor here: in the cells, the captains are the leaders.”[530]
There is a set of “unwritten rules” for which captains impose
sentences in the cell.[531]
Cell captains in some facilities hold night-time “courts” in their
cells, with a trial in front of the other inmates,[532] where
they administer “justice” in the form of beatings or other
punishments. According to Chiluba, 32:

At night we also have judges and police officers in the
cells. The prison officers tolerate. Cell captains, they try to beat us using
heavy shoes, and tell us that “if you report, we’ll kill you in the
night and tell the prison officers that you died.” The court process
takes 30 minutes. They can also give cleaning punishments. Offenses include
quarrelling and fighting.[533]

According to one detainee, the outcome of these court
sessions is never in doubt: “People are always found guilty.”[534]

The forms of punishment administered by cell captains vary.
Most common inmate-inflicted punishments include cleaning, fetching water, or
sleeping in a less desirable area of the cell.[535]
Inmates also routinely reported frequent corporal punishment inflicted by cell
captains.[536]
Though a few inmates claimed that cell captains do not beat prisoners[537]
and one captain at Mwembeshi told us “we don’t punish them, we try
to explain to them the importance of cleaning the cell,”[538]
the vast majority of inmates reported that cell captains did administer
corporal punishment. Kennedy—a remandee—reported that the cell
captains use whips, belts, or electric cable to beat other inmates, usually
10-20 times.[539]
Another inmate at Lusaka Central said that he had witnessed canings with a pipe
meted out by cell captains, in some cases punishing attempted rape.[540]
Albert, 30, reported:

In the cell, there are the voiceless and there are the
privileged...Special stages would order the beating if there is sodomy inside
or someone is found with drugs. They would be beaten with a hosepipe, with
shoes. After I have seen inmates bleeding from the skull, who are taken to the
clinic to get painkillers.[541]

Showing his scars, Martin, 39, told us: “My fellow
inmates, the bluebands, they beat us hard for no reason. We cannot complain to
prison officers because they do not allow us to complain. They subject us to
beatings in lock up when the guards are not there. It’s dangerous to
fight back, they can kill you.”[542] Another inmate at
Mumbwa reported that remandees are whipped with a cane by convicts, and that he
once was stoned by a captain when he asked to go to the toilet.[543]
At Mumbwa, we also heard a report that one inmate tried to escape from the open
farm camp and was beaten almost to death by cell captains. Rendered blind by
his injuries, he was at the clinic in town.[544]

Often, such beatings are conducted at the instigation of
officers, who incite cell captains to do what they cannot, as a way of
subverting prohibitions on officer-inflicted corporal punishment. Moses, 24, noted,
“the officers don’t beat us except [in cases of] sodomy, just the
cell captains do. But they know the captains beat us, and they say, ‘that
is my captain.’”[545]

International standards require that “every prisoner
shall have the opportunity each week day of making requests or complaints to
the director of the institution or the officer authorized to represent
him” and shall be able to make requests or complaints to the inspector of
prisons and central prison administration.[546]
Under Zambian law, officers in charge are required to ensure that prisoners who
have complaints are able to make them to the officer in charge personally.[547]

While inmates at some facilities reported that they had been
able to make complaints to the commissioner of prisons about various aspects of
their treatment, officer complicity in cell captain abuse means that inmates do
not have immediate recourse when they are abused. One inmate at Mumbwa, with
swollen hands, told us: “I was beaten by the captains for complaining too
much. This was recent. I can’t complain to the officers as they will tell
the captains and then I will be beaten again.”[548]
Another inmate at Mumbwa reported being beaten to a prison officer, “who
told us we were thieves and have to experience this torture.”[549]

Officer-sanctioned beatings by inmates are particularly
virulent when inmates want to punish cases of “sodomy,” and we
heard repeated testimony from both inmates and prison officers about the
extremely violent attacks that result when an inmate is discovered to have
engaged in sexual activity with another inmate. Indeed, said Chiluba, 32,
“the whole cell can beat one for sodomy or masturbating”[550];
reported another, “we just beat them.”[551]
Keith, 32, described an incident in which consensual sexual partners in the
condemned section were discovered, and inmates began to beat those involved.[552]
Mumba, 44, was injured at the time of the interview as a result of intervening
in another such beating:

As we speak, I have a broken rib right now because we
wanted to excise someone and take him to the officers. The man was from another
cell—I was told he had committed sodomy. People wanted justice in their
own hands. When we tried to take him to the officers, we were attacked by an
angry mob. The man was rescued, and rushed into the clinic, but I was beaten....The
other partner was beaten in the night. People fear if such activities happen,
and want to take the law into their own hands, to make an example of someone as
a deterrent. Why the fear? That is a question of every person’s mind.
They think that the punishment is too lenient because they think sodomy is
wrong. Also there is the HIV issue—they don’t want it to spread in
prison.[553]

In some cases, prisoners expressed what they believed to be
religious grounds for hostility against homosexuals. “In my
religion,” Luc, 36, an immigration detainee at Lusaka Central, told us,
“you have to be killed for that.”[554]

Inmate-inflicted beatings can result in serious health
consequences. As Chilufya, 29, reported:

Many have need of medical treatment after a beating and one
ended up dying after a beating in Chimbokaila [Lusaka Central Prison]. A cell
captain came and gave him a beating and he wanted to retaliate with a hoe.
After that, all the other captains came and beat him. He complained of chest pains
and they kept him here for four days, then took him to the clinic which then
referred him to UTH [the University Teaching Hospital]. I learnt later from one
of the officers who’s a driver that he’s died.[555]

Other forms of punishment which were reported as having been
inflicted by cell captains were more unusual. Peter, a teenager, reported that at
Choma, captains and older inmates—at the instigation of
officers—beat younger inmates when they complain about the living
conditions to outsiders, and make them shout “yes sir” for hours at
a time:

When we complain about the living conditions, we are
beaten. The captains and older inmates beat us—slapping or punches....The
officers tell the captains to beat us. After people come to visit, they call us
to ask if we said the living conditions are bad. If we say yes, they beat us.
They will call all five of us to ask what we were asked, and they will beat us.
When people come to ask [about prison conditions] and [the interviewers] break
confidentiality, the captains get to know who said what. They are paraded in
the cell, interrogated, and beaten.

Some people complained to the officer in charge and it
rolled back to them. We complained to the commissioner when he passed through,
but later on we were beaten for that. I was given the punishment of shouting
“inde-e bwana mukubwa,” [yes, sir] for four hours. The guards are
the ones with the problems, not the captains. The guards come to talk to the
captains, say that we are dirtying our image—we are put “on
lecture” [standing on the toilet in the cell for four hours, shouting
“yes, sir,” with beatings if you stop]. If you don’t shout,
you are beaten. They ask you to bend, and they beat you on your upper back. We
were given instructions a long time ago—when visitors come, don’t
make a matter of the living conditions....There is nothing good about this
place, the only good thing about this place is getting out.[556]

Other unusual punishments also exist: At Mwembeshi, Jonathan,
35, reported that “in winter, the captains will take you to the pump and
pour water on you and then beat you in the cold. It is an all day torture
because your clothes are cold and wet.”[557]
Mangazi, 37, at Mumbwa, said that another punishment consisted of holding a
water container over one’s head for two hours, and being beaten if one
drops it.[558]

Inmates accused of beatings, especially in cases of
suspected same-sex sexual activity, appear to be rarely punished.[559]
While some officers in charge seem to fulfill their function as a complaint
mechanism, by accepting confidential complaints, investigating and punishing
the offender, others do not. The officer in charge at Mumbwa admitted that cell
captains do beat other inmates—“it is nature when they provoke each
other—that is normal.” However, she claimed that while cell
captains may be demoted if they are discovered by the officers, this has
happened “not a lot.”[560]
The deputy officer in charge at Mumbwa informed us that captains are generally
not allowed to beat inmates, but when the prison officer is far away, they can
in private; captains are generally not punished.[561]

Hard Labor

At farm, I dig drains with a pick. I get very bad chest
and body pains. Sometimes I come to a place where I feel I am dying.

– Aaron, 26, HIV-positive inmate, Choma Prison,
October 8, 2009

Inmate and officer abuse of power were particularly evident
at the prisons we visited with associated farm facilities, where inmates’
sentences to hard labor resembled a form of slave labor through a total lack of
payment, beatings in the fields by the cell captains (referred to by inmates as
“masters”) when an inmate was perceived to work too slowly, no
water or toilet facilities, and forced labor at officers’ personal farms
after completing work at the prison farm.

International standards on work require that “prison
labour must not be of an afflictive [internationally causing distress]
nature.”[562]
International standards further specify that the “maximum daily and
weekly working hours of the prisoners shall be fixed by law or by
administrative regulation,” and shall leave one rest day a week and
sufficient time for education and rehabilitation activities.[563]
Zambian law requires that prisoners not be required to do any labor on Sundays.[564]
The conditions of the hard labor at farm prisons are detrimental to
prisoners’ health and do not meet Zambian and international law and
standards.

Prisoners routinely work every day of the week.[565]
The officer in charge at Mumbwa confirmed that inmates work eight hours a day,
seven days a week.[566]
Noah, 32, at Mumbwa described the conditions of such work:

It is a marathon—you are not supposed to stop and
stretch. If they see you do that, you are in trouble. You cannot drink water
unless it’s time, even if you are very thirsty. The ground is hard and
hard to dig. If you take a break, the captains will shout at you. They want to
force you to do work, and only at designated times can you rest. Otherwise,
they are always on you. At times, some of the captains may shout and yell at
you—others may go to the extent to whip you. They tell us, “you
criminal, a criminal is not supposed to get tired—continue
working.”[567]

Chibesa, 27, at Mwembeshi, described similar hard labor
conditions:

We work all day without food. That is why people run away.
Recently five tried to escape. There is no opportunity to take a bath after the
work day. Sometimes we bathe only two times a week. When you are working in the
fields and all hot and dusty and you ask for a drink of water, the officer
tells the captain to beat you. This happens repeatedly. Two weeks ago,
someone’s feet started swelling and they said he was lying. They took him
to the hospital and after two days he died. We are suffering. Even on Sunday
they still have to work. They only let us stop for the visiting hour—they
let us clean up and our family thinks everything is ok. But we are suffering.[568]

While PRISCCA, ARASA, and Human Rights Watch did not visit a
farm prison where women were engaged in hard labor, we heard from a former
inmate at Mukobeko that female prisoners incarcerated there face many of the
same challenges as men engaged in hard labor: Female prisoners facing hard
labor are treated “like slaves” by the officer in charge,
being made to clean her house and wash her clothes; and prisoners are forced to
work every day, often at the officer in charge’s farm, without ever
eating any of the produce that they have “sweated for.”[569]

The complete unavailability of water for inmates doing hard
labor in the hot sun all day is an especially serious health concern: The
officer in charge at Mwembeshi admitted “we ration water,” but also
claimed that “the captains go and draw water for the inmates when they
need it from the water pipe.”[570]
Repeatedly from inmates, we heard that water was not provided. Reported one,
“when we are out in the fields, there are some boreholes, but the
captains refuse to fetch water for the prisoners.”[571]
“We are not given a chance to drink water unless the officer is kind and
you can beg them. Often we work eight straight hours without water,” said
Mwelwa, at Choma.[572]
An inmate at Mwembeshi reported that: “The only water is put at the end
of the field and we can only drink if we finish our work. But then they move it
again so by the time you get to the end, it has been moved. One guy fainted
last week due to heat and lack of water.[573]

Hard labor poses particular health problems for some HIV-positive
prisoners. While by Zambian law, medical officers are ordered—where
practicable—to examine every prisoner before the prisoner is made to do
work,[574]
some HIV-positive inmates are still made to work in the fields despite a
weakened health condition.[575]
At Mumbwa, Semba, 34—a remandee—reported: “Everyone must
work, even those that are sick. The labor may consist of breaking stones for
three to four hours a day. There is no payment. Both remandees and
convicts must work.”[576]

Inmates serving sentences for hard labor are also taken
outside the prison to work at individuals’ farms. Furthermore, inmates at
Mumbwa and Mwembeshi repeatedly reported having to work at some of the prison
officers’ personal fields:

If there is no urgent work Monday through Saturday or even
Sunday, the prison officers take us to their own fields. In the rainy season,
we knock off at 13 hours—and in the afternoon, we have to go to work in
the officers’ fields, they divide the numbers. The officer in charge is
not aware of some of these things. He is a new officer in charge, and seems to
be a very good man. But the officers use their hands to beat us.[577]

While the officer in charge at Mwembeshi reported that
inmates do not work on Sundays, or on holidays,[578]
inmates claim that working (without pay) in the officers’ fields in the
afternoons or on Sundays is routine: “In the officers’ fields, you
do the same work you normally do. We go normally every day. The officers go
with you, say it is time for ‘wenga wenga’—it means after you
have finished the work of the government, you have to go for the
officers’ work.”[579]

Under Zambian law, prisoners are to be paid their accumulated
earnings upon release[580]
and are eligible for payment when the commissioner authorizes the introduction
of an earnings scheme in any prison.[581]
However, the schedule of payment for prisoners under such an earning scheme in
Zambian law is between one kwacha (US$0.0002) a day and three kwacha ($0.0006)
a day.[582]
These derisive sums mean that inmates never receive payment for their work.
Frederick Chilukutu, the deputy commissioner of prisons informed us that with a
one kwacha per day requirement, “if you get it now, what can you use it
for? It’s nothing.” Therefore, he explained, since paying prisoners
one kwacha per day became “irrational,” the Prisons Service has
halted payment entirely, a situation which the he admits needs to be reviewed
in order to better provide released inmates with money to sustain and establish
themselves outside of prison.[583]
Currently, no prisoner ever receives money for work when they leave.[584]
Forcing inmates to work in effect without pay is a form of forced labor that
violates international norms.

Compounding the already dangerous environment of the farm
prisons, in the fields, inmate “masters” are given a free hand to brutally
abuse their fellow inmates. From inmates at these prisons, researchers
repeatedly heard the same story: “the captain will beat people if they
fall behind” while the officers look on and even tell them to do the
beating.[585]
Indeed, “it’s a regular, daily event that we are beaten.”[586]
From the beginning of the day, when the captains call out for labor, walking
through the group with whips,[587]
to the fields—when inmates fashion whips out of tree
branches—beating is routine. Kaila, 20, reported that at the Mumbwa open
farm prison a master beat him “all the time...for no reason” with
the officers watching. “It’s just cruelty,” he concluded.
Attempts to complain to the officer in charge had not had lasting effect.[588]

These beatings were confirmed by the masters themselves,[589]
one of whom reported that “the officers don’t let you beat too
much” but went on to admit that he “would beat the inmates badly
sometimes”[590]
and that “we are permitted to beat people in the fields.”[591]
While one captain posited that brutality had improved due to human rights
education, he admitted that other captains wanted to “run the prison in
the old way, as they did 10 years ago when beating was happening here, there,
everywhere.”[592]
Festus, 35, an inmate at Mwembeshi, remarked, “I was chosen to supervise
but refused because I feel pity.”[593]

Officers are routinely complicit in this abuse, and in fact
sometimes order it.[594]
Despite the fact that the officer in charge at Mwembeshi had told the captains
not to beat their fellow inmates, an inmate reported that “the officer
will force the captain to beat [inmates in the fields] if they are too tired to
move.”[595]
Jacob, 26, another inmate at Mwembeshi, reported:

The officers see—they are the ones who instruct the
masters. They say “tunga nyeleti.” That means—how can I say
it?—“push the needle.” It means you have to be beaten, that
it’s time for a beating now. The masters beat us because they are
instructed.[596]

Even when officers don’t explicitly order the beating
in the field, captains abusing their fellow inmates are not decisively
punished.[597]
While complaints to a well intentioned officer in charge do sometimes result in
disciplinary measures against captains who have been their fellow inmates,[598]
after complaints, “there are retaliations in the field” by the
captains.[599]

Criminal Justice System and
Its Impact on Prison Health

In 2007, the UN Human Rights Committee noted that
“[t]o the extent that the State party [Zambia] is unable to meet the
needs of detainees, it should immediately take action to reduce the prison
population.”[600]
Prisoner overcrowding—and the health consequences of that
overcrowding—are inextricably linked to failings in the criminal justice
system which engage the responsibility of the Zambian judiciary, police,
immigration, and prisons authorities. Interviews with inmates, prison officials
and NGOs found such problems as police investigation failures, lack of bail,
and lack of representation for accused persons keep individuals unnecessarily,
and often unlawfully, incarcerated for extended periods of pre-trial detention.
For prisoners who have been tried, failures of the justice system such as lack
of alternative non-custodial sentences, and delays in the appeals process,
continue to contribute to the overcrowding.

Extended and Arbitrary Pretrial
Detention

Justice delayed is
justice denied. It is better even to be found guilty. When you come out, you’ve
spent 10 years in prison. Remandees are kept here a long time. I have [been
detained] four years now, but my case is not disposed of. There is no justice.

– Rodgers, 42, Lusaka Central Prison, October 3, 2009

Delays and failures within the Zambian criminal justice
system lead to unnecessary arrests and detainees being held for long periods of
time on remand prior to appearance before a judge and prior to trial, contrary
to international and Zambian law. This can have disastrous results for the
individuals’ health and lives. The incarceration of pre-trial detainees
is clearly a major contributing factor in the prisons’ extreme
overcrowding, as remandees are held with convicts in violation of international
law. On the day PRISCCA, ARASA, and Human Rights Watch visited Lusaka Central
Prison, of the 1145 inmates, 601—more than half—were there on
remand.[601]
Overall, 35 percent of the Zambian prison population is composed of remand
prisoners.[602]

International and regional law provide for the individual
right to liberty and prohibit arbitrary arrest and detention.[603]
Yet prisoner testimony indicates that problems in police investigation result
in many unnecessary and wrongful arrests. According to inmates, police arrest
and hold alleged co-conspirators or family members when their primary targets
cannot be found. Such detentions, irrespective of provisions in Zambian law
permitting them, are arbitrary and unlawful under international law. Catherine,
38, a Lusaka Central inmate, recounted, “the police officers and DEC [Drug
Enforcement Commission] officers come here, they bring people here who are
innocent. They will pick up a whole family and bring them here.”[604]
Angela, 23, also at Lusaka Central, concluded: “The reason the prisons
are congested is that they arrest entire families when they just are looking for
one person. They will arrest six at a time, even old ladies who can’t
walk.”[605]
Police officials noted to PRISCCA, ARASA, and Human Rights Watch the need for
professional education and sensitization so that officers “don’t go
beyond their role” and so that, in the future, “if they detain
unlawfully, the person is released.”[606]
Such wholesale arrests may, in some cases, even be sanctioned by law, as the
Zambian police[607]
and drug enforcement officials have expansive powers to detain and arrest.[608]
They still, however, violate Zambia’s international human rights
obligations with respect to the right to liberty.

Upon arrest, international, regional, and Zambian law
provide for the right to be brought before a judge, and to be charged or
released.[609]
Ninety-seven percent of the prisoners PRISCCA, ARASA, and Human Rights Watch
interviewed had not seen a magistrate or judge within 24 hours of arrest, even
though such review is required under Zambian law.[610]
Indeed, far from seeing a magistrate or judge within the first 24 hours after
arrest, the prisoners we interviewed had in many cases been detained for months
without ever having seen a magistrate or judge to review their detention. On
average, male detainees we interviewed in all six prisons spent four months in
detention prior to seeing a judge or magistrate for the first time; female
detainees spent one month. Yet survey data established that the average length
of time at some prisons was even longer: At Kamfinsa, male detainees averaged
nine months between arrest and first appearance before a judge; at Mukobeko
Maximum Security, male detainees had averaged five months. Additionally, we
spoke with inmates whose first appearance before a magistrate or judge was one
year and one month after arrest,[611]
one year and two months after arrest,[612] two years after
arrest,[613]
and three years and seven months after arrest.[614]

Table 11: Appearance before
a Judge

International law requires that “[p]re-trial detention
should be an exception and as short as possible.”[615]
The UN Human Rights Committee has made clear that detention before trial should
be used only to the extent that it is lawful, reasonable, and necessary.
Necessity is defined narrowly: “to prevent flight, interference with
evidence or the recurrence of crime” or “where the person concerned
constitutes a clear and serious threat to society which cannot be contained in
any other manner.”[616]
International standards provide that except in special cases, a person detained
on a criminal charge shall be entitled to release pending trial subject to
certain conditions.[617]

Yet for individuals awaiting trial in Zambia, there is
insufficient use of noncustodial pretrial alternatives. Among the prisoners we
interviewed, 95 percent of juveniles, 88 percent of adult males, and 75 percent
of adult females were continuously detained from arrest (not having been
released on police bond or bail).

Table 12: Continuous
Detention

Inmates frequently reported that they were unaware of the
right to request bail.[618]
Bail is explicitly prohibited for numerous offenses including treason, murder,
aggravated robbery, and narcotics violations.[619] Judges
also use their discretion to deny bail, saying “bail is not a right, but
a privilege.”[620]
When bail was an option, inmates frequently reported that they had not been
able to obtain bail.[621]
In 2008, the Human Rights Commission of Zambia concluded that “there are
incidences of individuals in remand for offences for which bail could have duly
been granted either because of their socio-economic circumstances or lack of
knowledge that they can apply for bail.”[622]

Following their initial appearance in front of a magistrate
or judge, prisoners may then in practice be held for years before they face
trial. Under international and Zambian law, those charged with a criminal
offense are to be tried “without undue delay.”[623]
Yet “the long stay of prisoners without trial,” lamented Chishala,
38, “is unbearable.”[624]
Researchers spoke with convicted prisoners who—between arrest and
conviction—had been held on remand for six years,[625]
and one who had been held 10 full years between arrest and conviction.[626]
PRISCCA, ARASA, and Human Rights Watch also spoke with current remandees who,
still awaiting judgment, had been held for up to five years seven months.[627]
Among the prisoners we interviewed, the median time since being detained for
current remandees was a staggering 36 months (three years) for adult males,
with a minimum of one month and a maximum of 67 months (five years, seven
months). For juveniles, the median was five months, with a range from eight to
a high of 43 months (three years, seven months); for adult females the median
was one month, with a range from zero to 28 months (two years, four months).

Table 13: Median Time
in Detention for Remandees

Remandee Prisoner Category

Time in Detention (months) Reported by Remandees (median
(range))

Adults (19 years and
older) (n=27)

10 (0-67)

Males
(n=16)

36 (1-67)

Females (n=11)

1 (0-28)

Juveniles (8-18
years) (n=14)

5 (0-43)

All Remandees (n=41)

7 (0-67)

International standards mandate that persons who are charged
with a criminal offense be informed of their right to have access to a lawyer.[628]
Zambian law provides that individuals sent for trial before the High Court whom
the court considers have insufficient means to engage a lawyer, shall be
granted legal aid,[629]
and individuals in subordinate courts may apply for legal aid.[630] Researchers
found, however, that inmates had low levels of knowledge of their right to a
lawyer and low levels of representation. Indeed, 60 percent of adult male prisoners
and over 70 percent of adult female and juvenile prisoners reported no legal
representation whatsoever. Even children appearing before the High Court were
rarely represented by counsel. Erick, a teenager, reported:

I had no representation, I stood on my own behalf. It was
my first time in a police station or in court. I was just speaking, and I was
scared. So I didn’t know what I was saying.... As young people, it is
very threatening to see the inside of the court. Even if you are not guilty,
you end up pleading guilty.[631]

There is little by way of legal aid capacity, which means
only a few defendants benefit from legal assistance, and that assistance may be
of poor quality.[632]
As the Legal Resources Foundation observed, “the state legal aid is
supposed to be providing legal services, but they are not widespread. They are
appointed in capital cases and juveniles, but they should be in all criminal
cases. The lawyers also do a bad job: they say, ‘just plead
guilty.’”[633]

Table 14: Legal
Representation

Lack of legal counsel can lead directly to unnecessary
incarceration. Anderson, 35, an inmate at Choma, reported that he did not
intend to plead guilty, but the magistrate decided he should plead guilty and
“checked it on the form”.[634] In another case,
an inmate explained:

The victim was willing to forgive me, but friends and
family members told me to admit guilt. I had never been in court before, I had
no idea how it proceeds.... I plead guilty and was sentenced to one year.[635]

Judicial delays in case transfers between the subordinate
and the High Court, turnover between judges (which leads to a trial being
restarted), inefficiency among the prosecution service, and sporadic lack of
fuel for court transport all conspire to lengthen pre-trial detention. Frequent
adjournments delay trials, despite legal provision that in the cases of
individuals held in prison, no adjournment shall be for “more than
fifteen clear days.”[636]
Detainees reported that often when they go to court, the sessions don’t
take place, because the court is waiting for the prosecution to proceed,[637]
the lawyer or judge is not there,[638]
or because witnesses are not present. One inmate reported that he had been
appearing in court every three months for two years waiting for a police
officer to testify against him, but that the police officer had never shown up.[639]
And, sometimes, inmates are unable to go to court because of a lack of fuel or
transport from the prison to court.[640]
Thus, for myriad reasons, inmates’ cases are frequently not advanced,
leaving them bewildered. Banda, age 17, said: “I am here on remand; I
came on July 23, 2007. I am done with my trial, just waiting for judgment....The
trial didn’t take too long, it is only the judgment that has taken long.
It’s been a year and four months since my trial ended. I’ve been
back to court four times just for the judgment but it never comes.”[641]

Table 15: Immigration
Detainees’ Access to Justice

Prisoner Category

Prisoners Who Reported Seeing a Judge Since Being Detained (%)

Immigration
Detainees

38

Non-Immigration
Detainee Prisoners

97

Immigration detaineesare frequently detained and
await deportation without due process, mingled with convicted and remandee
prisoners. Zambian immigration law provides that suspected immigration
detainees may be detained for up to 14 days while inquires are made.[642]
Immigration service officials informed us that detention is the last resort,
but that a docket is prepared and put on file with the court if the case
involves someone whom they believe intentionally overstayed their visa.[643]
Delays may occur in bringing the detainee before the court if the immigration
detainee “doesn’t tell the truth...if people are lying, that is the
major source of delays, as the process of verification will take long.”[644]
Yet, Hope, 23, an immigration detainee at Lusaka Central, told us
“immigration just leaves people here. Some in our group have been here
six months without going to court, they don’t take you if you don’t
speak the language.”[645]
Susan, 36, at Lusaka Central, informed us that “one lady from Rwanda, brought
here, has been here for four months has never been to court, just staying here....Immigration
brings them and dumps them here.”[646] Among prisoners
we interviewed, only 38 percent of immigration detainees had ever seen a
magistrate or judge, compared with 97 percent of non-immigration detainees.

Many who were indefinitely detained appeared to have
reasonable claims to legal status. Among the immigration detainees we
interviewed, we spoke to some who claimed to be Zambian citizens and
non-citizens with valid visas, but had been unable to challenge their
designation as “prohibited immigrants” in court.[647]
One 18 year-old immigration detainee, whose mother is Zambian and father
Senegalese, but was raised in the Congo, showed immigration officials his birth
certificate when they arrested him, but was told, “‘You don’t
speak Bemba, you don’t speak English, you are not Zambian.” He
never received a charge document or had the opportunity to see a magistrate or
judge to contest his detention.[648]
Benjamin, 31, born in Zambia but raised in the Congo by his grandmother, never
had a birth certificate: “I thought it was ok because I was born in
Zambia and my father is a Zambian.”[649] Laurent, a
Congolese detainee who reported he had been in possession of a valid visa when
detained, reported:

I entered Zambia on September 29. I had a visa, I was given
26 days. I reached Kitwe and was going to the marketplace when a group arrested
me. They said, “give us your passport.” I refused and was taken to
the immigration office to be interviewed. I paid 2,000 [Zambian kwacha, US$0.42]
in immigration custody. I demanded to know why I was arrested and they said,
“We took you in for being arrogant.” It was a completely
illegal arrest, but I am just waiting here for anything to happen because my
passport and visa are at the immigration office.[650]

I’m a refugee in Solwezi Maheba Refugee Camp.... I
was arrested because I left the camp with no exit permit. And my children are
still there at the camp....I left the camp to visit my brother who was sick
with TB. He wasn’t here as a refugee, he was paying a visit. I was in a
hurry, it was an emergency situation, he was almost dead, so I didn’t ask
about what papers I needed to leave the camp; I just left. I have been here for
eight months. I have had no contact with my family, UNHCR, or anyone else, and
no visits. I have tried to write letters but they rip them up and don’t
send them. They are asking me for one million eight hundred kwacha [$380] to go
back to DRC.[651]

Immigration detainees are told to pay for their own
deportation and are held until they pay.[652] Jean Marie, 28, detained
at Lusaka Central, reported “I’ve been waiting to be deported to
DRC. I even offered to pay; I told the officers to call immigration and arrange
it but they haven’t. I’m ready to pay; I have money in reception.
My biggest problem is that they don’t help us. Some [immigration
detainees] have been here for two years waiting.”[653]
A Liberian detainee, whose wife and child were Zambian citizens but who
hadn’t applied for legal status, lamented “immigration came and
told me I had to pay my own transport, and if I don’t I have to stay here
maybe five or six years. I don’t have the money to deport myself and the
government says they don’t have the money to deport me. I don’t
want to leave my family, but in Liberia it would be better than prison.[654]
Immigration officials confirmed that “under normal circumstances, we
don’t ask for money to deport, but we do when we don’t have the
money ourselves...at times it may happen frequently that the budget for
deporting runs out.”[655]

We also spoke with immigration detainees who felt unable to
return to their country of origin and yet had not had the opportunity to
request asylum. A Somalian detainee reported “I left Somalia on March 1,
2009.... When they caught me I told the [immigration officials] that I want a
refugee camp, but no one helped me. UNHCR came once to [the prison]; they wrote
down my name but nothing happened.[656]
A Rwandan detainee who had been an opposition journalist told us, “I am
despairing because I see no way out of prison but can’t return home.
I’m looking at spending the rest of my life in prison.”[657]
Immigration officials, by contrast, claimed that all immigration detainees have
an opportunity to claim asylum, but sometimes fail to do so at the appropriate
time.[658]

Unnecessary
and extended detention for immigration detainees or remandees may have
significant financial costs both for the government and for the individual, in
addition to the personal toll that such detention may take. Families in
developing countries frequently face financial hardship when an income-producing
member is detained, particularly when the period of detention is long, and
detainees are unable to earn income, provide food for themselves and their
families, and pay taxes.[659] Even given Zambia’s grossly inadequate prison
conditions, the current cost to the government of incarcerating immigration and
remand detainees unnecessarily for extended periods is not insignificant, and
savings could likely be generated by increasing the use of bail instead of
pre-trial detention. Furthermore, state money expended on holding pre-trial or
immigration detainees unnecessarily represents “a stark opportunity cost,” for the government, as
“[e]very bit of state revenue spent on incarceration results in
potentially less money for crucial social services, health, housing, and
education.”[660]

Non-Custodial Sentences and
Parole

The unavailability of non-custodial sentences also
contributes to prison overcrowding. Zambian penal law provides for a range of
punishments—among which imprisonment is only one option[661]—including
the sentence of community service.[662]
However, the 2000 law providing for non-custodial sentences has had minimal
impact because of the lack of personnel to supervise those on community service
orders.[663]
Community service orders were placed under the authority of the Prisons
Service, but with no additional resources or staff to implement these orders.[664]

The lack of options to complete custodial sentences in the
community also exacerbates prison overcrowding. Parole has only recently become
practically available. While parole has been “on the books since the
inception of the nation, it has been dormant until relatively recently.”[665]
The parole system, however, is burdened by the irrational fact that only
inmates with longer sentences—those who have been found guilty of more
serious crimes—are eligible for parole, whereas inmates with more minor
sentences are ineligible. The legal requirement was originally a four-year
sentence; in 2001, the deputy commissioner of prisons reported, the Prisons
Service took the initiative to lobby for the law to be amended so that those
incarcerated for two years and more are eligible for parole. In 2008, parole
board members were appointed and prisoners were paroled in 2009[666]
and 2010. Yet the number of inmates paroled is low, in some cases because of a
lack of resources for follow-up. According to the officer in charge at
Mwembeshi:

We submitted a number of names of eligible inmates but only
one was chosen. The problem is that offender management can’t do follow
up on the parolees because she lacks a motorbike.[667]

Considering the irrationality of the certain sentence limits
on parole, to be truly meaningful, the deputy commissioner of prisons reported
that the requirement of two or more years needs to be eliminated, so that the
only restriction on the availability for parole would be those who are
sentenced to death.[668]

Appeals System

Under international law, everyone convicted of a crime has
the right to have his conviction and sentence reviewed by a higher tribunal
according to law.[669]
Yet in Zambia, the appeal process suffers from serious delays, which also
results in the unnecessary detention of some inmates. Delays in appeals, as in
pre-trial and trial proceedings, can go on for years. One inmate had been
informed that his appeal papers had been lost.[670]
Howard, 29, an inmate at Mukobeko, told us he had been waiting for eight years
for his appeal to be heard—when it comes to the appeals, he said,
“We are just hopeless.”[671]
Chishala, 38, reported “I have been waiting six years since I put in my
appeal, and I have heard nothing in that time.”[672]
Paul, 33, a condemned prisoner at Mukobeko, noted that:

My appeal has taken since 2005. I can no longer afford a
lawyer to move it through the system. We are 235 in the condemned section. Only
40 have had their appeals heard. 180 are still waiting, some for over 10 years.[673]

Emmanuel, 35, confirmed that people wait over 10 years.
Having waited four years already without resolution of his appeal,
“I’m doomed,” he concluded.[674]

Conclusion

According to international law, the penitentiary system
shall treat prisons with the essential aim of reformation and social
rehabilitation.[675]
International standards encourage, prior to prisoner release, prisons to take
steps to reintegrate the prisoner into society.[676]
Yet Zambia currently makes little, if any, provision for reintegration of
prisoners, an omission to which inmates attributed a significant recidivism
rate. One prisoner at Mwembeshi reported that “there is no planning with
us for release. For inmates, when we finish our sentence we face stigma in the
community....I used to see it when I was outside—and I am afraid it could
happen to me. When we go outside, we don’t have anything to do.”[677]
Another at Mumbwa reported, “there are no re-entry services. People are
poor when they get out, so they come right back.”[678]
One former prisoner reported being “destroyed” when he came out of
prison, financially and personally.[679]
“When you come out of prison, you are looked at as an outcast, not as a
human being,” said another.[680]

The officer in charge at Mwembeshi reported:

We need real rehabilitation. Many of the inmates here
are not criminally minded. Many crimes are circumstantial. People
commit offenses because they want to make a living. They need economic
empowerment. If one shows an interest in farming, we should help with
capital so they have a chance at a new life.[681]

The offender management officer at Mwembeshi concurred:
“On discharge people have nothing. We don’t have the resources to
bring them to their homes and they are stigmatized upon re-entry, causing
recidivism.”[682]

Keeping in mind that, typically, all but a small percentage
of prisoners return to the community,[683] and that the
prison community is inextricably linked to the general population,[684]
Zambian prisons need to improve conditions in the prisons and measures to
reintegrate their inmates into the general population post-release, as not
simply a matter of prisoner health, but a matter of public health.

Improving the conditions in Zambia’s prisons will
require significant changes on the part of the Zambia Prisons Service, and will
also require the coordinated efforts of actors throughout the Zambian
government, civil society, and international agency and donor communities. In
addressing general prison conditions, the Zambia Prisons Service will be unable
to effect necessary change without improved support from Parliament and the
international donor community. To improve the delivery of medical services to
prisoners, NGOs, international agencies and donors, and Zambian Parliament will
also play a role in improving the availability and accessibility of services.
To reduce the drastic overcrowding that now plagues the prisons, the Zambian
judiciary, Parliament, police, and immigration officials will be indispensable
in ensuring necessary changes to the law, implementation of non-custodial
alternatives, and increased efficiency of the judicial process. Clearly,
resource constraints are a major consideration, but greater priority on prison
funding needs to be put at the national level and greater support from international
donors needs to be forthcoming if change is to be effected. Some reforms—particularly
the proposed legal reforms—are resource-neutral; those that aren’t
are crucial to the realization of the rights of prisoners and are the
responsibility of both the national government and international donors.

Recommendations

To the Zambia Prisons Service and Ministry of Home Affairs

Increase the use of parole, including a
priority for ill detainees and pregnant and lactating detainees

Reform prisoner disciplinary systems by:

Suspending all use of penal block cells,
which currently violate the prohibition on inhuman treatment

Immediately discontinuing the practice of
stripping inmates naked and holding them in water while in penal block
confinement

Consistently punishing officers using
corporal or other inappropriate punishments

Immediately discontinuing a reliance on
separate cell captain justice systems, so that only prison officers decide on
or inflict punishment, in accordance with the Prison Act and Prison Rules

Consistently punishing cell captains judged
to have inflicted punishment on their fellow inmates, with aggravated punishments
for instances of cell captain-inflicted corporal punishment

Providing prison officers with additional
training in appropriate discipline methods and the inappropriateness of
corporal punishment, with prison officer-guided education sessions for all
inmates on prison rules and disciplinary methods and punishments

Ensuring detainees are able to send
confidential complaints to state bodies and other organizations, and that all
prison officials are aware of this right and do not interfere with it

Investigate all complaints of sexual assault
of inmates by other inmates or officers, and take appropriate action against
those found responsible

Investigate all complaints of physical,
verbal, and sexual assault and abuse, by inmates and officers, against inmates
suspected or charged with same-sex sexual conduct, whether in custody or prior
to incarceration, and take appropriate action against those found responsible

Establish clear guidelines on the provision
of prison-based health services, and scale up these services to:

Immediately establish the presence of a
clinical officer at each prison, who at the morning line-up can judge prisoner
health complaints and facilitate access to outside Ministry of Health medical
facilities, eliminating the use of cell captains and non-medical prison
officers from doing triage and deciding which prisoners are entitled to
evaluation and treatment

Ensuring prompt initiation on treatment for
those with confirmed disease

Conducting a TB prevalence study to
understand the true extent of the disease in the prisons

Establishing capacity for TB testing and
treatment at each prison clinic

Educating prison officers and cell captains
in TB symptoms and the necessity of referral for testing upon the appearance of
symptoms

Further educating prison medical officers in
the co-management of HIV and TB

Establishing clear guidelines and protocols
for moving patients into and out of TB isolation, with regular checks to ensure
that isolation is appropriate

Establishing guidelines on preventing
officer exposure to TB

Improving immediately the ventilation,
sunlight, and cleaning of TB isolation cells in line with international
standards

Prioritizing placing prisoners who are
HIV-positive and TST-positive on continuous Isoniazid Preventive Therapy (IPT)
for prevention of active TB as IPT becomes available, given the higher risk of
TB in the prison population

As testing and treatment for drug resistance
become available in the general population, ensuring full prisoner inclusion in
testing and treatment programs

Address HIV by:

Offering voluntary HIV counseling and
testing to all inmates entering prison and all existing inmates

Ensuring prompt initiation on treatment for
inmates with confirmed disease

Establishing HIV voluntary counseling and
testing and anti-retroviral therapy treatment and monitoring facilities at each
prison

Implementing a system for HIV voluntary
counseling and testing for pregnant inmates as part of a comprehensive system
of prenatal care, offering PMTCT where appropriate

Providing condoms and water-based lubricant
to all prisoners and prison officers

Providing HIV prevention, treatment, and
care education, including information and sensitization on harm reduction and
safer-sex practices in the context of same-sex sexual conduct at each prison to
increase condom acceptance

Systemic improvement:

Recruiting new prison officers to ensure
adequate staffing in all facilities, including security and healthcare staff

Conduct health screening of all prisoners
upon entry and at regular intervals

Establish clinics at each prison with at
minimum a clinical officer on staff, with a consistent supply of essential
medications and a minimum capacity to conduct TB testing and treatment and HIV
voluntary counseling and testing and anti-retroviral therapy treatment and
monitoring

Establish a comprehensive monitoring and
evaluation system that records prison illness and deaths

Increase the use of mobile health services
to rural prisons and improve transport from rural prisons to health facilities
to improve healthcare availability

Create a system for continuity of care for
inmates upon discharge to include a summary of the inmate’s medical record
and a temporary supply of TB or HIV medication where necessary

Develop more comprehensive links and
formalized protocols with Ministry of Health clinics that now provide most care
to Zambian prisoners.

Ensure that conditions of confinement meet
international standards, including by taking immediate action to improve basic
prison conditions by:

Renovating prison facilities, to provide
every detainee with a bed of his or her own, and adequate space, light, and
ventilation

Ensuring strict separation of children from
adults; males from females; convicted from unconvicted detainees; and immigration
detainees from criminal detainees

Providing food, at a minimum as established
by the dietary scale in the Prisons Rules, including separate rations for
children living with their mothers, and additional rations for prisoners with
HIV, TB, and other health conditions requiring nutritional supplements

Ensuring adequate supply of clean water, in
particular at regular intervals for prisoners engaged in hard labor in the
fields

Constructing a sufficient number of sanitary
toilet facilities for the current number of inmates, inside and outside of
cells

Providing prisoners with basic necessities
including adequate clothing/uniforms, blankets and mattresses, mosquito nets, soap,
and razors, as well as gloves, disinfectant, rodent and insect extermination
materials, and other equipment for safely completing their cleaning duties

Limiting the number of hours worked by
inmates under sentence of hard labor

Ending the practice of inmates working at
officer farms and implementing prisoners’ right not to work on Sundays

Providing inmates with meaningful
compensation for prison work upon release

Protecting officers and prisoners from
infectious disease by creating facilities for hand-washing

Increase the Prisons Service’s focus
on prisoner rehabilitation and reintegration through increasing the
availability of education programs in prison and improved reentry planning

To the Zambian Parliament

Repeal or amend Sections 155, 156, and 158
of the Penal Code in order to decriminalize consensual sexual conduct among
adults, and implement gender-neutral laws to protect both adults and children
from sexual violence and assault

Raise the minimum age of criminal
responsibility from eight to an age in line with international standards. In
line with the Committee on the Rights of the Child, Human Rights Watch
recommends an age of at least 14 years, with 12 years as the absolute minimum

Limit police and Drug Enforcement Commission
powers to carry out sweeping, group arrests which violate international law

Amend the Prisons Act and Prisons Rules to:

Eliminate the exclusion of prisoners with
sentences under two years from the parole program

Revise the guidelines on pay for prisoner
work to bring them in line with inflation and make compensation meaningful

Amend the Immigration Act to:

Require that any administrative detention
for the purposes of deportation be shown on a case-by-case basis to be
proportionate and necessary

Allow that immigrants who are ordered
deported by a court be given a time frame to depart the country that does not
presume or require their detention

Include specific limits on the duration of
administrative detention for the purposes of deportation

Secure enough funding for the budget for
Zambian prisons, so that there are enough resources to ensure conditions
consistent with international standards. Funding should be sought for:

Facility renovation

Upgrading of water and sanitation facilities
to ensure the availability of clean water and sanitary and adequate toilet
facilities at all prisons

Food and cooking facilities, so that food
provision meets national and international standards

The provision of basic necessities to
prisoners, including soap and adequate clothing

The Parole Board

Take the necessary steps to ensure that the existing
legal provision for non-custodial sentences can be invoked, including by
identifying an authority responsible to the Prisons Service who would oversee
its implementation

To the President of Zambia

Issue a public statement identifying prison
conditions and health as a national crisis and establish a high-level
inter-ministerial task force to urgently develop a national prison health plan

Establish an inter-ministerial commission to
increase collaboration, coordination, and cooperation among the prison, police,
judiciary, and immigration authorities on reducing prison overcrowding,
including the identification of steps necessary to achieve reduction of
overcrowding and a timetable for implementation

Publicly oppose the criminalization of consensual
sexual activity, including same-sex sexual activity, and encourage the
provision and use of HIV prevention methods including condoms in prisons

To the Zambian Judiciary and Ministry of Justice

Issue guidelines for bail administration to
encourage granting of bail and easing of surety requirements, considering
accurate information about household incomes in Zambia

Ensure that all magistrates and judges know
and advise defendants on their rights—particularly bail and
representation rights—when they are brought before them to be charged

Speed proceedings by:

Streamlining the process of case transfer
from subordinate to High Court

Providing for judicial cooperation so that
retirement, absence, or death of a judge does not necessitate the
recommencement of a trial

Strictly limiting adjournments

Abiding by all statutory requirements for
when defendants need to be seen in court

Ensure all detainees, including those under
18, have access to a lawyer of their choice

Ensure defendants who do not have legal representation
are provided with adequate assistance to ensure that pleadings are completely
understood, witnesses are adequately questioned, and the accused understands
his rights and options

Review the position of all offenders
currently in pre-trial detention, with a view to releasing them on bail, and
ensure effective non-custodial alternatives for defendants awaiting trial

Ensure that pre-trial detention is for as
short a period as possible and subject to regular review

Ensure that children are subject to
pre-trial detention only as a last resort

To the Zambia Police Service and Drug Enforcement
Commission

Cease all arbitrary arrests including the
practice of detaining family members and witnesses when the primary
investigation target cannot be found

To the Zambia Ministry of Home Affairs/ Immigration Department

Ensure that each detainee receives a hearing
in a timely manner

Ensure each detainee’s ability to
request asylum

Reform the system for payment of deportation
costs

Minimize the use of detention for
immigration offenses

To
the Zambia Ministry of Health

Develop a detailed plan for the improvement
of prison health services and conditions in its National Health Plan 2011-2015

To the Zambia National Human Rights Commission

Investigate and publish reports on
violations of the rights of individuals on the grounds of real and perceived
sexual orientation and gender identity and expression in Zambia, raising
awareness of both legal and extra-legal forms of violence and discrimination

Integrate discussion of prison health into
existing technical advisory committees on health to the Zambian government

Provide financial support for scaling up
legal assistance programs for prisoners, in order to speed progression of cases
through the judicial system

Develop community reintegration programs,
halfway houses, and microfinance initiatives to assist prisoners with reentry
and decrease the risk of recidivism

Ensure regular visits by UNHCR to prisons to
ensure that refugees are not held in prisons and that detainees have an
opportunity to claim asylum

Acknowledgements

This report was written by Katherine Wiltenburg Todrys,
Bernstein fellow in the Health and Human Rights division at Human Rights Watch,
based on research by the author and Megan McLemore, researcher, Rebecca
Shaeffer, Kroll Family fellow, and Darin Portnoy, consultant, in the Health and
Human Rights division at Human Rights Watch; Nyaradzo Chari-Imbayago, advocacy
coordinator at ARASA; and Chris Mumba, treatment literacy officer at the
Treatment Advocacy and Literacy Campaign.

Kathleen Myer, consultant with the Health and Human Rights Division
at Human Rights Watch, assisted with data entry and analysis; research into
donor activities in Zambia was conducted by Sarah Pierce, intern with the
Women’s Rights Division at Human Rights Watch. Mignon Lamia, associate in
the Health and Human Rights Division at Human Rights Watch, provided editing
and production assistance. Anna Lopriore, creative manager and photo editor, Kyle
Knight, associate in the Children’s Rights Division, Grace Choi,
publications director, and Fitzroy Hepkins, mail manager, all of Human Rights
Watch, provided production assistance. Human Rights Watch would also like to
thank Giulio Frigieri for the creation and design of the map and João
Silva for photography.

A number of people provided invaluable assistance in the
research and preparation of this report. Special thanks go to Godfrey
Malembeka, himself a former prisoner, who provided coordination for the
research mission and interpretation, as well as to Kelvin Musonda, Shadreck
Lubita, Rodgers Siyingwa, and George Chikoti of PRISCCA, who served as
interpreters and provided coordination assistance. PRISCCA, ARASA, and Human
Rights Watch also acknowledge the assistance of the Zambia Prisons Service in
permitting access to prison facilities, especially the Commissioner Gibbie
Nawa, Deputy Commissioner Frederick Chilukutu, and the Ministries of Foreign
Affairs and Home Affairs for clearing researchers and granting authority for
this research.

PRISCCA, ARASA, and Human Rights Watch thank all of the
individuals who agreed to be interviewed for this report. We are particularly
grateful to all of the prisoners and prison officers whom we met and
interviewed. Their willingness to share information and their experiences with
us made this report possible.

Appendix: Request for Information to the Zambia Prisons
Service

[1]
Under Zambian law, a prisoner under the age of nineteen years (the minimum age
of criminal responsibility is eight years) is classified as a “juvenile,”
despite the fact that under international law, 18 year-olds are adults.
Throughout this report, the term “juvenile” will be used to
designate the category of prisoners ages eight to 18 held in Zambian prisons
when necessary to refer to the classification used by the government.
Otherwise, individuals in prison under age 18 will be referred to as
“children” in accordance with the Convention on the Rights of the
Child.

[2]In 2003, the Zambia Human
Rights Commission reported that its “inspections revealed serious
situations of congestion, filth, disease, inadequate food and poor water and
sanitation facilities. Generally inmates lacked decent sleeping facilities and
uniforms….Health and medical services were almost non-existent or poor in
the majority of the prisons. The major diseases included tuberculosis, diarrhea
and scabies….Inmates complained of torture, delayed justice, poor living
conditions, inadequate food and poor medical attention.” Zambia Human
Rights Commission, “Annual Report: 2003,” 2003, pp. 1 and 12. In
2005, the UN Committee on Economic, Social and Cultural Rights expressed
concern about the “living conditions of prisoners and detainees,
especially with regard to access to health-care facilities, adequate food and
safe drinking water.” UN Committee on Economic, Social and Cultural
Rights, “Consideration of Reports Submitted by States Parties under
Articles 16 and 17 of the Covenant: Concluding Observations of the Committee on
Economic, Social and Cultural Rights: Zambia,” Thirty-fourth session, 25
April-13 May 2006, E/C.12/1/Add.106, June 23, 2005, para. 28, http://www.unhchr.ch/tbs/doc.nsf/c12563e7005d936d4125611e00445ea9/04e80cf87aa13784c125700500465779/$FILE/G0542576.pdf
(accessed February 22, 2010).

[12]In 2003, the Zambia Human Rights Commission reported
that “[h]ealth and medical services were almost non-existent or extremely
poor in the majority of the prisons. Prison clinics have either closed down due
to lack of personnel, drugs and other basic essentials…or they exist
without any personnel or essential drugs.” Zambia Human Rights
Commission, “Annual Report 2003,” p. 15.

[13] In Zambia, clinical
officers typically have three years of post-secondary school training and the
capacity to prescribe medications. PRISCCA, ARASA and Human Rights Watch
interview with Dr. Chisela Chileshe, director, Zambia Prisons Service Medical
Directorate, Lusaka, February 6, 2010.

[18]
World Bank, "Implementation, Completion and Results Report on a Grant in
the Amount of SDR 33.7 million to the Republic of Zambia for the Zambia
National Response to HIV/AIDS (Zanara) Project in Support of the Second Phase
of the Multi-Country Aids Program for Africa," February 27, 2009,
http://www-wds.worldbank.org/external/default/WDSContentServer/WDSP/IB/2009/04/01/000333038_20090401005842/Rendered/PDF/ICR9220ZM0P00310Disclosed0031301091.pdf
(accessed March 1, 2010), pp. 67-68.

[19]
Ministry of Health and National HIV/AIDS/STI/TB Council, "Zambia: National
AIDS Spending Assessment for 2005 and 2006: Final Draft Technical Report,"
July 2008,
http://data.unaids.org/pub/Report/2008/nasa_zambia_0506_20080721_en.pdf
(accessed March 2, 2010), p. 82.

[44]UNODC, UNAIDS and World Bank, “HIV and Prisons in
Sub-Saharan Africa: Opportunities for Action,” p. 2. E. Rutta et
al., “Tuberculosis in a Prison Population in Mwanza, Tanzania
(1994-1997),” The International Journal of Tuberculosis and Lung
Disease, vol. 5(8), 2001, pp. 703-06.

[45]
According to the World Health Organization, multi-drug resistant TB is
“is a specific form of drug-resistant TB due to a bacillus resistant to
at least isoniazid and rifampicin, the two most powerful anti-TB drugs.”
Drug resistance “arises due to the improper use of antibiotics in
chemotherapy of drug-susceptible TB patients. This improper use is a result of
a number of actions, including administration of improper treatment regimens by
health care workers and failure to ensure that patients complete the whole
course of treatment. Essentially, drug-resistance arises in areas with poor TB
control programmes.” World Health Organization, “Drug- and
Multi-Drug Resistant Tuberculosis (MDR-TB)—Frequently Asked
Questions,” undated, http://www.who.int/tb/challenges/mdr/faqs/en/index.html
(accessed March 1, 2010).

[66]Protocol to the African Charter on Human and Peoples' Rights
on the Rights of Women in Africa, adopted by the 2nd Ordinary Session of the
Assembly of the Union, Maputo, CAB/LEG/66.6 (Sept. 13, 2000); entered into
force Nov. 25, 2005.

[67]United Nations (UN) Standard Minimum Rules for the
Treatment of Prisoners (Standard Minimum Rules), adopted by the First United
Nations Congress on the Prevention of Crime and the Treatment of Offenders,
held at Geneva in 1955, and approved by the Economic and Social Council by its
resolution 663 C (XXIV) of July 31, 1957, and 2076 (LXII) of May 13, 1977,
paras. 57-58; United Nations (UN) Human Rights Committee, General Comment 21,
Article 10, Humane Treatment of Persons Deprived of Liberty (Forty-fourth
session, 1992), Compilation of General Comments and General Recommendations
Adopted by Human Rights Treaty Bodies, UN Doc. HRI/GEN/1/Rev.7 (1994), paras.
3-4; Basic Principles for the Treatment of Prisoners, adopted December 14,
1990, G.A. Res. 45/111, annex, 45 U.N. GAOR Supp. (No. 49A) at 200, U.N. Doc.
A/45/49 (1990), principle 5.

[74]
UN Standard Minimum Rules for the Treatment of Prisoners; Body of Principles
for the Protection of All Persons under Any Form of Detention of Imprisonment
(Body of Princniples), adopted December 9, 1988, G.A. Res. 43/173, annex, 43
U.N. GAOR Supp. (No. 49) at 298, U.N. Doc. A/43/49 (1988); Basic Principles for the Treatment of Prisoners.

[81]Universal
Declaration of Human Rights (UDHR), adopted December 10, 1948, G.A. Res.
217A(III), U.N. Doc. A/810 at 71 (1948), art. 25(1); International Covenant on
Economic, Social and Cultural Rights (ICESCR), art. 12. The right to health is also
guaranteed by a number of other international human rights treaties and
commitments that bind Zambia. The Convention on the Rights of the Child obligates
states to “recognize the right of the child to the enjoyment of the
highest attainable standard of health and to facilities for the treatment of
illness and rehabilitation of health. States Parties shall strive to ensure
that no child is deprived of his or her right of access to such health care
services.” Convention on the Rights of the Child, art. 24. The right to
the health is recognized by the International Convention on the Elimination of
All Forms of Racial Discrimination and in 11.1(f), 12 and 14(2)(b) of the
Convention on the Elimination of Discrimination Against Women. The right to
health has been proclaimed by the Commission on Human Rights, the Vienna
Declaration and Programme of Action of 1993 and other international
instruments. UN Committee on Economic, Social and Cultural Rights,
“Substantive Issues Arising in the Implementation of the International
Covenant on Economic, Social and Cultural Rights,” General Comment No.
14, the Right to the Highest Attainable Standard of Health, E/C.12/2000/4
(2000), http://www.unhchr.ch/tbs/doc.nsf/0/40d009901358b0e2c1256915005090be?Opendocument
(accessed February 22, 2010), para. 2.

[83]The African Charter on Human and Peoples’
Rights guarantees the right to health and requires states parties to
“take the necessary measures to protect the health of their people and to
ensure that they receive medical attention when they are sick.” African
[Banjul] Charter on Human and Peoples’ Rights, art. 16. See also,
Southern African Development Community (SADC) Protocol on Gender and
Development, art. 26.

[96]The US State Department report from 2009 acknowledged
rates of overcrowding to the extent that some inmates were forced to sleep
sitting upright, and noted that “[p]oor sanitation, dilapidated
infrastructure, inadequate and deficient medical facilities, meager food
supplies, and lack of potable water resulted in serious outbreaks of dysentery,
cholera, and tuberculosis, which the overcrowding exacerbated.” US
Department of State, “2009 Human Rights Report: Zambia.” In 2007,
the Human Rights Committee “expresse[d] concern at the intolerable rate
of prison overcrowding and the very poor conditions in places of
detention” and called on Zambia to develop alternatives to imprisonment.
Indeed, it recommended that “To the extent that the State party is unable
to meet the needs of detainees, it should immediately take action to reduce the
prison population.” UN Human Rights Committee, “Consideration
of Reports Submitted by States Parties under Article 40 of the Covenant:
Concluding Observations of the Human Rights Committee: Zambia,” U.N. Doc.
CCPR/C/ZMB/CP/3 (2007), pp. 6-7. In 2008, the Committee Against Torture
expressed concern regarding “the severe overcrowding in detention
facilities.” Committee Against Torture, “Consideration of Reports
Submitted by States Parties Under Article 19 of the Convention: Concluding
Observations of the Committee Against Torture: Zambia,” U.N. Doc.
CAT/C/ZMB/CO/2 (2008), http://daccess-dds-ny.un.org/doc/UNDOC/GEN/G08/421/29/PDF/G0842129.pdf?OpenElement
(accessed March 2, 2010), para. 15

[100]
Ibid. In fact, each of the six prisons we visited far exceeded its design
capacity: Kamfinsa Prison, built with a design capacity of 1000, housed 1494
inmates. PRISCCA, ARASA, and Human Rights Watch interview with Patrick Mundianawa,
officer in charge, Kamfinsa Prison, October 1, 2009. At Mumbwa Prison, a
facility built to hold 150 inmates held 354 on the day of our
visit—sometimes the facility holds as many as 460. PRISCCA, ARASA, and
Human Rights Watch interview with officer in charge, Mumbwa Prison, October 5,
2009. Choma prison holds 251, though it was built with a capacity of 120.
PRISCCA, ARASA, and Human Rights Watch interview with Patrick Chilambe, officer
in charge, Choma Prison, October 8, 2009.

[103]
Prisoners PRISCCA, ARASA, and Human Rights Watch interviewed will be cited by
unique pseudonym or by a unique code assigned to each prisoner interviewed by
researchers, indicating the initials of the interviewer, the date of the
interview, and assigning each prisoner interviewed a number. PRISCCA, ARASA,
and Human Rights Watch interview with Hastings, Mukobeko Maximum Security
Prison, September 29, 2009; PRISCCA, ARASA, and Human Rights Watch interview
with KT-29-05, Mukobeko Maximum Security Prison, September 29, 2009.

[141]
According to prisoners at Mukobeko and Lusaka, sometimes the same portion of
450g is divided into two pieces so as make it appear to be two meals.

[142]
PRISCCA, ARASA, and Human Rights Watch interview with Noah, Mumbwa Prison,
October 5, 2009. The revenues from prison farm labor reportedly are placed into
a fund called the Prison Industry Revolving Fund (PIRF). This scheme was
created with the understanding that “the government is not managing to
feed [prisoners] well because of other demands on the treasury.”
Reportedly, the yearly food budget for 2009 was 10 billion kwacha
(US$2,110,510), but the Prisons Service would ask for 65 billion kwacha
($13,718,300) if it were not for the existence of the PIRF. The
“excess” produced at the farms is sold to generate income. PRISCCA,
ARASA, and Human Rights Watch interview with Frederick Chilukutu, deputy
commissioner of prisons, Zambia Prisons Service, October 12, 2009.

[167]
Prisons Act, sec. 56. Zambian policy also provides that these children shall be
provided with food. See Zambia Prisons Service, “Zambia Prisons Service
HIV and AIDS/STI/TB Strategic Plan (2007-2010),” p. 7 (“Similarly,
there are some infants and young children who are imprisoned along with their
mothers. By definition these children are under the care of the State—in
this case Prisons Service. It is important to recognise these children’s
rights and their needs, i.e. necessary facilities and actions to promote the
health and wellness of these children and reduce their vulnerability to HIV and
AIDS, STIs and TB.”); Zambia Prisons Service, “HIV &
AIDS/STI/TB Workplace Policy,” p. 25 (“Children
born with HIV should receive appropriate treatment and nutrition through
linkages with public health systems and other cooperating partners.”).

[178]
The Zambia Human Rights Commission in 2005 corroborated that “[t]oilet
and sanitation facilities were either broken down or nonexistent in most cases.
Sewer and sanitation infrastructure were dilapidated and posed a serious health
hazard.” Zambia Human Rights Commission, “Annual
Report: 2005.”

[208]Some officers in charge
have been particularly proactive in engaging the church and NGO communities and
soliciting such support. PRISCCA, ARASA, and Human Rights Watch interview with
Patrick Chilambe, officer in charge, Choma Prison, October 8, 2009.

[221]
Since 2003, the Zambia Human Rights Commission has confirmed that
“prisoners’ uniforms…were in a terrible state….Even
where ‘uniforms’ were available, they were often in tatters and
left the inmates bare.” Zambia Human Rights Commission,
“Annual Report: 2003,” p. 15.

[230]
In December 1994, a study of the impact of HIV/AIDS programs in Zambian prisons
found that 8.4 percent of respondents reported same-sex sexual activity,
although indirect questioning suggested a much higher percentage. O. Simooya et
al., “Sexual Behavior and Issues of HIV/AIDS Prevention in an African
Prison,” AIDS, vol. 9(12), 1995, pp. 1388-89. The 1998-99
prevalence study found that “[a]lthough only 3.9 percent of inmates
reported having sex with other men, the figures may be much higher. When we
invited inmates to indicate how common sex between men was at their prison,
over 50 percent replied that many were involved, and 6 percent said that almost
all were involved.” Oscar O. Simooya et al., “‘Behind
Walls’: A Study of HIV Risk Behaviors and Seroprevalence in Prisons in
Zambia,” AIDS, vol. 15(13), 2001, pp. 1741-44. UNODC, UNAIDS, and
the World Bank have acknowledged that “[c]ommon high-risk behavior in the
prison environment include unprotected sex (mostly anal and between males),
rape, sex bartering and “prison marriages.” Additionally,
“women in prison are also susceptible to sexual exploitation and may
trade or be forced to trade sex for food, goods or drugs with other prisoners
or staff.” UNODC, UNAIDS and World Bank, “HIV and Prisons in
Sub-Saharan Africa,” p. 1. Additionally, “women in prison are also
susceptible to sexual exploitation and may trade or be forced to trade sex for
food, goods or drugs with other prisoners or staff.” Ibid., p. 9.

[239]
PRISCCA, ARASA, and Human Rights Watch interview with Evans, Lusaka Central
Prison, October 4, 2009. See also, “we have had experiences where the
older inmates become physical and abuse us, even sexually. They will offer me
food mixed with drugs, and when I take it in the night I sleep without being conscious.
Or cigarettes dipped in some drugs. If it works, I sleep and they abuse me in
the night, even sexually.” PRISCCA, ARASA, and Human
Rights Watch interview with David, Lusaka Central Prison, October 3, 2009.

[244]
PRISCCA, ARASA, and Human Rights Watch interview with J. Kababa, officer in charge,
Lusaka Central Prison, October 3, 2009. PRISCCA, ARASA, and Human Rights Watch
were unable to verify what these exams consist of, and whether they are
conducted with consent, as none of the prisoners we interviewed reported having
had such an exam. If conducted without genuine consent, however, physical exams
under these conditions could constitute torture.

[248]
Furthermore, international standards provide that “the medical services
of the institution shall seek to detect and shall treat any physical or mental
illnesses or defects which may hamper a prisoner's rehabilitation. All
necessary medical, surgical and psychiatric services shall be provided to that
end.” UN Standard Minimum rules for the Treatment of Prisoners, para. 62.
Every institution must have at least one qualified medical officer, access to
dentistry services, and transfer of sick prisoners requiring specialist
treatment to specialized institutions or civil hospitals. Ibid., para. 22. See
also Basic Principles for the Treatment of Prisoners, prin. 9.

[269]Multidrug-resistant TB is
defined as tuberculosis caused by Mycobacterium tuberculosis resistant in vitro
to the effects of isoniazid and rifampicin, the two most powerful anti-TB
drugs, with or without resistance to any other drugs. World Health
Organization, “Guidelines for the Programmatic Management of
Drug-Resistant Tuberculosis,” 2006, http://whqlibdoc.who.int/publications/2006/9241546956_eng.pdf
(accessed March 3, 2010), p.1.

[272]
World Health Organization and International Committee for the Red Cross,
“Tuberculosis Control in Prisons: A Manual for Programme Managers,”
2002, http://whqlibdoc.who.int/hq/2000/WHO_CDS_TB_2000.281.pdf (accessed March
3, 2010), p. 15.

[273]
One of six classes of drugs not used in the standard regimen of treatment for
TB, to which resistance may have developed.

[282]
Advisory Council for the Elimination of Tuberculosis, “Prevention and
Control of Tuberculosis in Correctional Facilities Recommendations of the
Advisory Council for the Elimination of Tuberculosis,” MMWR, vol.
45(RR-8), June 7, 1996, pp. 1-27.

[294]
United Nations Office on Drugs and Crime (UNODC), World Health Organization and
the Joint United Nations Programme on HIV/AIDS (UNAIDS), “HIV/AIDS
Prevention, Care, Treatment and Support in Prison Settings: A Framework for an
Effective National Response,” 2006, http://data.unaids.org/pub/Report/2006/20060701_hiv-aids_prisons_en.pdf
(accessed March 1, 2010).

[300]
PRISCCA, ARASA, and Human Rights Watch interview with Felix Mwanza, TALC, October
15, 2009. Since 2000, PRISCCA has been operating at Lusaka Central, and has
conducted HIV education and sensitization in each of the six prisons we
visited. PRISCCA, ARASA, and Human Rights Watch interview with Godfrey
Malembeka, executive director, PRISCCA, Johannesburg, November 23, 2009.

[310]
World Health Organization, “Nutrient Requirements of People Living with HIV/AIDS:
Report of a Technical Consultation, Geneva, Switzerland, 13-15 May 2003,”
2003, http://whqlibdoc.who.int/publications/2003/9241591196.pdf (accessed March
1, 2010).

[329]
“The failure to provide inmates with the means to protect themselves
against HIV and AIDS and other infectious diseases is seen to be an
infringement of their basic rights. Measures to protect staff and inmates
against HIV and other infectious diseases are therefore needed urgently.”
Zambia Prisons Service, “Zambia Prisons Service HIV and AIDS/STI/TB Strategic
Plan (2007-2010),” p. 2.

[333]
As Human Rights Watch has reported, Zambian “sodomy laws” are a
result of nineteenth-century British colonial legislative impulse towards
social and sexual control of their subject populations in Asia and Africa. See
the Human Rights Watch report “This Alien Legacy: The Origins of
‘Sodomy Laws’ in British Colonialism” for an exploration of
the imposition of sexual and social regulation laws on former British colonies,
http://www.hrw.org/en/reports/2008/12/17/alien-legacy.

[378]
According to Médecins Sans Frontières, “ As people on
antiretroviral treatment (ART) develop intolerable side effects or start to
develop resistance to their first set of antiretroviral medicines (ARVs), they
need to switch to a different drug combination. Compliance to treatment is
important to prevent viral resistance, which will allow the HIV virus to
replicate and mutate. In one of MSF’s long-standing HIV/AIDS projects, in
Khayelitsha, South Africa, 16 percent of patients need to be switched to
‘second-line’ therapy after five years of treatment. Indeed, in
wealthy countries, many people living with AIDS have changed their treatment
lines four, five or even six times. With two million people on ARVs across the
developing world, the need for access to newer ARV options is growing
rapidly.” Médecins Sans Frontières, “Need for Newer
Drugs,” July 2009,
http://www.msfaccess.org/main/hiv-aids/introduction-to-hivaids/need-for-newer-drugs/
(accessed March 2, 2010).

[384]
Dr. Chileshe confirmed that when remandees are referred to the hospital, they
are handcuffed to the bed. PRISCCA, ARASA, and Human Rights Watch telephone
interview with Dr. Chisela Chileshe, October 13, 2009.

[426]
The UN Population Fund has reported that between 72 and 90 percent of women in
Zambia’s general population receive prenatal care. UN Population Fund,
“Recognizing the Needs in Zambia,” undated, http://www.unfpa.org/fistula/docs/eng_zambia.pdf
(accessed March 2, 2010).

[449]
PRISCCA, ARASA, and Human Rights Watch interview with Robby Shabwanga, projects
officer, Legal Resources Foundation, October 14, 2009. See also PRISCCA, ARASA,
and Human Rights Watch interview with Angela, Lusaka Central Prison, October 4,
2009 (“They don’t open the door in the cell at night for anything.
There are no windows, no air. Someone who was 28 years old died at night in her
cell and they didn’t open the door until the morning.”)

[453]The officer in charge at Mukobeko reported that there
had been four inmate deaths in the previous month and 10 inmate deaths in 2008 at
the time of our visit, 40 percent of which were attributable to TB. PRISCCA,
ARASA, and Human Rights Watch interview with George S. Sikaonga, officer in
charge, Mukobeko Maximum Security Prison, September 29, 2009. At Kamfinsa, the
officer in charge said that there had been two deaths in 2009 until October,
four in 2008, all from HIV/AIDS. PRISCCA, ARASA, and Human Rights Watch
interview with Patrick Mundianawa, officer in charge, Kamfinsa Prison, October
1, 2009. At Mumbwa Prison, the officer in charge reported that three deaths had
occurred in 2009, and one in 2008, all from HIV/AIDS and TB. PRISCCA, ARASA,
and Human Rights Watch interview with officer in charge, Mumbwa Prison, October
5, 2009. At Choma prison, the officer in charge reported to us that in 2009
there had been two inmate deaths from TB and HIV/AIDS-related illness and a
short illness, respectively. In 2006, HIV/AIDS was the leading cause of death. PRISCCA,
ARASA, and Human Rights Watch interview with Patrick Chilambe, officer in charge,
Choma Prison, October 8, 2009.

[491]
PRISCCA, ARASA, and Human Rights Watch interview with KT-04-01, Lusaka Central
Prison, October 4, 2009 (“The guards used to ask other inmates to beat people,
but we complained to the Human Rights Commission and it stopped. They fear we
will tell the outside, so it has stopped.”).

[493]
Juveniles at Mukobeko reported being made to draw water for the TB patients as
punishment. PRISCCA, ARASA, and Human Rights Watch interview with Chris,
Mukobeko Maximum Security Prison, September 29, 2009. A female prisoner at
Kamfinsa reported digging and weeding as punishment for fighting. PRISCCA,
ARASA, and Human Rights Watch interview with NCI-02-01, Kamfinsa Prison,
October 2, 2009. Men at Lusaka Central reported manual work as punishment
including cleaning toilets and sweeping. PRISCCA, ARASA, and Human Rights Watch
interview with Rodgers, Lusaka Central Prison, October 3, 2009. Others reported
having to dig pit latrines or sweep. Female inmates at Lusaka Central reported
having to water the plants and to clean the toilets as punishment for refusing
to dance as part of newcomer orientation rituals. PRISCCA, ARASA, and Human
Rights Watch interview with KT-04-04, Lusaka Central Prison, October 4, 2009;
PRISCCA, ARASA, and Human Rights Watch interview with Annie, Lusaka Central
Prison, October 4, 2009.

[494]
The UN Standard Minimum Rules for the Treatment of Prisoners specify that
“[t]here shall be no discrimination on grounds of race, colour, sex,
language, religion, political or other opinion, national or social origin,
property, birth or other status.” UN Standard Minimum Rules for the Treatment
of Prisoners, para. 6(1). See also Body of Principles, prin. 5 (“These
principles shall be applied to all persons within the territory of any given
State, without distinction of any kind, such as race, colour, sex, language,
religion or religious belief, political or other opinion, national, ethnic or
social origin, property, birth or other status.”); Basic Principles for
the Treatment of Prisoners, prin. 2 (“There shall be no discrimination on
the grounds of race, colour, sex, language, religion, political or other
opinion, national or social origin, property, birth or other status.”).

[499]
In 2007, the UN Human Rights Committee, in its concluding observations in
Zambia, welcomed the abolition of corporal punishment through amendments to the
Penal Code, Criminal Procedure Code, the Prisons Act, and the Education Act but regretted lack of information on the practical implementation
of this abolition. UN Human Rights Committee, “Concluding
Observations of the Human Rights Committee: Zambia,” 2007, p.2. The Committee on the Rights of the Child in 2003 remained “concerned
that corporal punishment is still practised and accepted in schools, families,
and care and juvenile detention institutions.” Committee
on the Rights of the Child, “Concluding Observations: Zambia,” U.N.
Doc. CRC/C/15/Add.206 (2003), http://www.unhchr.ch/tbs/doc.nsf/898586b1dc7b4043c1256a450044f331/1a481056be1936eac1256da5004d40ea/$FILE/G0342771.pdf
(accessed March 3, 2010), para. 56.

[520]
At Mukobeko Maximum Security Prison, 72 officers oversee 1731 prisoners, an
officer-to-inmate ratio of one to 24. PRISCCA, ARASA, and Human Rights Watch
interview with George S. Sikaonga, officer in charge, Mukobeko Maximum Security
Prison, September 29, 2009. At Kamfinsa, the staff-to-inmate ratio is one to 12.
PRISCCA, ARASA, and Human Rights Watch interview with Patrick Mundianawa,
officer in charge, Kamfinsa Prison, October 1, 2009. At Lusaka Central, the
officer in charge reported 116 staff members for a population of 1145, a ratio
of one to 10. PRISCCA, ARASA, and Human Rights Watch interview with J. Kababa,
officer in charge, Lusaka Central Prison, October 3, 2009. At Mumbwa, 36 staff
members oversee 354 inmates, a ratio of one to 10. PRISCCA, ARASA, and Human
Rights Watch interview with officer in charge, Mumbwa Prison, October 5, 2009.
At Mwembeshi, 51 officers supervise 342 inmates, a ratio of one to 7. PRISCCA,
ARASA, and Human Rights Watch interview with officer in charge, Mwembeshi
Prison, October 6, 2009. At Choma prison, 39 staff members supervise 251
inmates (a ratio of one to 6), a number considered by the officer in charge to
be insufficient. PRISCCA, ARASA, and Human Rights Watch interview with Patrick
Chilambe, officer in charge, Choma Prison, October 8, 2009.

[523]
The Prisons Service has made proposals to increase this number and hopes to increase
it to 5,000 in the next three to five years. PRISCCA, ARASA, and Human Rights
Watch interview with Frederick Chilukutu, deputy commissioner of prisons, Zambia
Prisons Service, October 12, 2009.

[584]
PRISCCA, ARASA, and Human Rights Watch interview with KT-06-09, Mwembeshi
Prison, October 6, 2009. Prisoners at non-farm prisons who work in carpentry,
tailoring, or other workshops also receive no payment for their work. The
officer in charge at Mukobeko told us that “in terms of the Act, they are
supposed to be paid, but they are paid nothing now, only in colonial
times.” PRISCCA, ARASA, and Human Rights Watch interview with George S.
Sikaonga, officer in charge, September 29, 2009. The officer in charge at Choma
confirmed: “In terms of prison regulations, these prisoners are entitled
to payment, but these regulations have not been revisited since colonial times
and the monthly entitlement of 30 Ngwe in payment is virtually
worthless.” PRISCCA, ARASA, and Human Rights Watch interview with Patrick
Chilambe, officer in charge, Choma Prison, October 8, 2009.

[605]
PRISCCA, ARASA, and Human Rights Watch interview with Angela, Lusaka Central
Prison, October 4, 2009. See also PRISCCA, ARASA, and Human Rights Watch
interview with Susan, Lusaka Central Prison, October 4, 2009. International
observers have confirmed these findings. The US State department has found that
in practice, police rarely obtained warrants for those offenses for which
warrants are required (offenses including treason, sedition, defamation of the
president, unlawful assembly, or abuse of office are excluded) and police
arbitrarily arrested family members of criminal suspects, as well as arresting
criminal suspects on inadequate evidence or as a means of extortion.
Additionally, “[a]uthorities sometimes
detained, interrogated, and physically abused family members of criminal
suspects to obtain their cooperation in identifying or locating
suspects.” US Department of State, “2008 Human Rights Report:
Zambia.” Furthermore, “[p]olice arbitrarily arrested family members
of criminal suspects. Criminal suspects were arrested on the basis of
insubstantial evidence, uncorroborated accusations, or as a pretext for
extortion.” US Department of State, “2009 Human Rights Report:
Zambia.”

[610]
In addition to a requirement a police officer making an arrest without a
warrant shall send the person before a magistrate without unnecessary delay,
Zambian law requires that “[w]hen any person has been taken into custody
without a warrant for an offence other than an offence punishable with death,
the officer in charge of the police station to which such person shall be
brought may, in any case, and shall, if it does not appear practicable to bring
such person before an appropriate competent court within twenty-four hours
after he was so taken into custody, inquire into the case, and, unless the offence
appears to the officer to be of a serious nature, release the person, on his
executing bond, with or without sureties, for a reasonable amount, to appear
before a competent court at a time and place to be named in the bond: but,
where any person is retained in custody, he shall be brought before a competent
court as soon as practicable.” Criminal Procedure Code Act, sec. 33(1).

[623]ICCPR, art. 14; Body of Principles, prin. 38. See also Constitution
of Zambia, art. 18 (“(1) If any person is charged with a criminal
offence, then, unless the charge is withdrawn, the case shall be afforded a
fair hearing within a reasonable time by an independent and impartial court
established by law.”)

[677]
PRISCCA, ARASA, and Human Rights Watch interview with KT-06-03, Mwembeshi
Prison, October 6, 2009. See also PRISCCA, ARASA, and Human Rights Watch
interview with KT-06-06, Mwembeshi Prison, October 6, 2009 (“The other
problem is, when we are coming out, the government does not give you anything
to start with. When someone’s life is destabilized, he needs a ladder.
This is a very big problem. It makes some come back here several times, because
once he goes out, he has nothing to do. When we go out, the government should
give small capital to start a job. There is no planning for our
release.”); PRISCCA, ARASA, and Human Rights Watch interview with Agnes,
Kamfinsa Prison, October 1, 2009 (“The major problem affected the other
inmates here—there is no addressing of post-discharge, how to cope with
our life that we left. The prison administration does not address it—they
look at the now, not at the future. I have had some education
sessions—mainly dealing with acquiring capital to start a small business.
But I need practical skills in tailoring. It is hard to stay here for one year
doing nothing.”).

[678]
PRISCCA, ARASA, and Human Rights Watch interview with Andrew, Mumbwa Prison,
October 5, 2009. See also PRISCCA, ARASA, and Human Rights Watch interview with
Japhet, Mumbwa Prison, October 5, 2009 (“Our economy cannot sustain that,
the prisons need to ensure that people’s skills are improved or used, or
one will go back to crime. It needs to change and develop, all jails in Zambia
are congested. There needs to be a broader approach to introduce jobs in jail.
People come here and leave worse off than when they first arrived.”);
PRISCCA, ARASA, and Human Rights Watch interview with Mwisa, Choma Prison,
October 8, 2009 (No re-entry programs, that is why people come back to
prison.”).